Epicardial Metastases Causing Coronary Artery Compression and Myocardial Infarction on [18F]FDG PET-CT

Joshua Wilcox; Ankur Gulati; Elias Pintus; Andrew D'Silva; Manil Subesinghe

doi:10.1097/RLU.0000000000005819

Epicardial Metastases Causing Coronary Artery Compression and Myocardial Infarction on [18F]FDG PET-CT

Clin Nucl Med. 2025 Apr 11. doi: 10.1097/RLU.0000000000005819. Online ahead of print.

Authors

Joshua Wilcox^{1

2}, Ankur Gulati^{2

3}, Elias Pintus^{4

5}, Andrew D'Silva^{1

2}, Manil Subesinghe^{6

7}

Affiliations

¹ School of Cardiovascular Medicine & Sciences, King's College London.
² Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust.
³ Departments of Cardiology.
⁴ Oncology, Lewisham and Greenwich NHS Trust.
⁵ Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust.
⁶ King's College London & Guy's and St. Thomas' PET Centre.
⁷ Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London.

PMID: 40209234
DOI: 10.1097/RLU.0000000000005819

Abstract

A 64-year-old woman with metastatic lung adenocarcinoma on immune checkpoint inhibitor (ICI) therapy suffered an acute coronary syndrome and underwent percutaneous coronary intervention (PCI). Despite PCI and anti-anginal therapy, she continued to experience angina. Cardiac magnetic resonance imaging (CMR) suggested a diagnosis of ICI myocarditis. However, refractory angina and non-resolving changes on CMR despite high-dose steroids prompted further evaluation with [18F]FDG PET-CT; this yielded a final diagnosis of epicardial metastatic coronary artery compression with myocardial infarction. This case demonstrates the incremental diagnostic value of multimodality imaging in cardio-oncology.

Keywords: FDG; PET; cardiac magnetic resonance imaging (MRI); cardiac tumor; cardio-oncology; immune checkpoint inhibitor; myocarditis.