King s Research Portal

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1 King s Research Portal Link to publication record in King's Research Portal Citation for published version (APA): Webb, J., Frigiola, A., Carr-White, G., & Chiribiri, A. (2016).. Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rights Copyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights. Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research. You may not further distribute the material or use it for any profit-making activity or commercial gain You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. Download date: 09. Nov. 2018

2 Journal: Article DOI: Article title: First Author: Corr. Author: European Heart Journal ehv269 INSTRUCTIONS 1. Author groups: Please check that all names have been spelled correctly and appear in the correct order. Please also check that all initials are present. Please check that the author surnames (family name) have been correctly identified by a pink background. If this is incorrect, please identify the full surname of the relevant authors. Occasionally, the distinction between surnames and forenames can be ambiguous, and this is to ensure that the authors full surnames and forenames are tagged correctly, for accurate indexing online. Please also check all author affiliations. 2. Figures: If applicable figures have been placed as close as possible to their first citation. Please check that they are complete and that the correct figure legend is present. Figures in the proof are low resolution versions that will be replaced with high resolution versions when the journal is printed. 3. Missing elements: Please check that the text is complete and that all figures, tables and their legends are included. 4. Special characters: Please check that special characters, equations, dosages and units, if applicable, have been reproduced accurately. 5. URLs: Please check that all web addresses cited in the text, footnotes and reference list are up-to-date, and please provide a last accessed date for each URL. Please specify format for last accessed date as: Month Day, Year. 6. Funding: Please provide a Funding statement, detailing any funding received. Remember that any funding used while completing this work should be highlighted in a separate Funding section. Please ensure that you use the full official name of the funding body, and if your paper has received funding from any institution, such as NIH, please inform us of the grant number to go into the funding section. We use the institution names to tag NIH-funded articles so they are deposited at PMC. If we already have this information, we will have tagged it and it will appear as coloured text in the funding paragraph. Please check the information is correct. 7. Conflict of interest: All authors must make a formal statement indicating any potential conflict of interest that might constitute an embarrassment to any of the authors if it were not to be declared and were to emerge after publication. Such conflicts might include, but are not limited to, shareholding in or receipt of a grant or consultancy fee from a company whose product features in the submitted manuscript or which manufactures a competing product. The following statement has been added to your proof: Conflict of Interest: none declared. If this is incorrect please supply the necessary text to identify the conflict of interest.

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5 NOT FOR PUBLIC RELEASE Copy Edited by: K.R. Language used: UK/ize CARDIOVASCULAR FLASHLIGHT doi: /eurheartj/ehv ,2 *, Alessandra Frigiola 1, Gerry Carr-White 1, and Amedeo Chiribiri 2 1 Department of Cardiology, Guy s and St. Thomas NHS Foundation Trust, London SE1 7EH, UK; and 2 Division of Imaging Sciences and Biomedical Engineering, King s College London, 4th Floor Lambeth Wing, London SE1 7EH, UK * Corresponding author. jessica.webb@kcl.ac.uk Q1 A 65-year-old man with no cardiac risk factors presented to our Accident and Emergency department with dizziness and palpitations over the preceding week but no chest pain, breathlessness, or syncope. On examination blood pressure was 120/94 with a heart rate of 170 bpm. Electrocardiogram showed a wide QRS complex tachycardia compatible with a sustained monomorphic ventricular tachycardia (Panel A) originating from the inferior left ventricle. Amiodarone was started and the tachycardia terminated. Transthoracic echocardiogram demonstrated a nondilated left ventricle with asymmetric septal hypertrophy and associated hypokinesis. Coronary angiography confirmed non-obstructive coronary arteries. Cardiac magnetic resonance imaging revealed localized thickening in the mid inferoseptal, mid inferior, and mid inferolateral segments measuring maximally 22 mm with associated hypokinesis. Cine imaging showed evidence of an intra-myocardial mass (Panel B). On late gadolinium enhancement there was a ring enhancing pattern with areas of inner areas of signal void, which could indicate an avascular necrotic core (Panel C). These images support the diagnosis of a malignant intra-myocardial lesion. This patient s detailed history revealed an antecedent right renal cell carcinoma (RCC) treated with a laparoscopic right radical nephrectomy [previous computed tomography (CT) imaging, Panel D]. A recent CT scan had demonstrated lung metastases. The cardiac mass was not resectable and given the patient s history, the most likely explanation was an RCC metastasis. Haematogenous cardiac RCC metastastes is incredibly rare with more common cardiac involvement due to venous extension through the renal vein and inferior cava, and some even extending to the right atrium. Panel A Monomorphic ventricular tachycardia with right bundle branch block and superior axis. Panel B Cardiac magnetic resonance image, four chamber view demonstrating evidence of intra-myocardial mass in the mid septum (arrow). Panel C Cardiac magnetic resonance image, late gadolinium enhancement in the intra-myocardial mass with areas of inner areas of signal void (arrow). Panel D Abdominal computed tomography showing a renal cell carcinoma in the upper pole of the right kidney (arrow). Q2 Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author For permissions please journals.permissions@oup.com.