Malignite İlişkili Pulmoner Venöz Basıya Bağlı Psödo-Anterior MI
Özet
60 yaşında, kronik hastalığı bulunmayan erkek hasta hemoptizi yakınmasıyla acil servise başvurdu. Anjina veya anjina varyantı yakınmaları mevcut olmayan hastanın EKG’sinde anterior derivasyonlarda (V1-V6, D1-aVL) ST-segment elevasyonu ve ekokardiyografide ejeksiyon fraksiyonu 43 olarak hesaplandı, anterior ve apikal duvarlarda bölgesel duvar hareket kusuru saptandı. Akut anterior STEMI ön tanısıyla acil primer koroner anjiyografi (KAG) uygulanan hastada koroner arterler normal olarak görüntülendi. İşlem sonrası laboratuvar sonuçlarında Troponin değerinin 1945 ng/L olduğu görüldü. Yapılan ileri tetkiklerde sağ inferior pulmoner vene bası yapan malign bir kitle saptandı. Bu vakada, mediastinal kitlelerin mekanik ve inflamatuar etkileriyle STEMI tablosunu hem elektriksel hem de biyokimyasal olarak nasıl taklit edebileceği tartışılmaktadır.
A 60-year-old male with no prior chronic illness presented to the emergency department with sudden-onset hemoptysis and no symptoms of chest pain. Initial electrocardiography (ECG) revealed significant ST-segment elevation across the anterior leads (V1-V6, D1-aVL) without reciprocal changes. Bedside echocardiography demonstrated a reduced left ventricular ejection fraction (43%) with anterior and apical hypokinesia. Based on the strong clinical and imaging suspicion of acute anterior STEMI, the patient was emergently referred for primary coronary angiography (CAG) before biochemical markers were available. CAG revealed normal coronary arteries, excluding obstructive coronary pathology. Subsequent laboratory results showed a significantly elevated high-sensitivity Troponin level of 1945 ng/L. Thoracic CT and PET-CT imaging later identified a 7 cm mediastinal mass (Squamous Cell Carcinoma) causing severe compression of the right inferior pulmonary vein, leading to localized venous congestion. This case highlights a rare clinical phenomenon where mechanical effects of a malignancy mimic both the electrical and biochemical hallmarks of a STEMI, emphasizing the role of "pseudo-infarction" in differential diagnosis.
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