he reported chronic non - productive cough , weakness for the preceding three weeks , loss of appetite , and weight loss of about ten kilograms in six months .
the interview and the medical history documentation indicated that he was suffering from diabetes type 2 , paroxysmal atrial fibrillation , hypertension , chronic renal failure grade 3 , and from generalised atherosclerosis . at age 45
it was located in segment 6 of the right lung , with diameter of 4.5 cm and lysis in the centre .
in addition , the ct revealed in the enlarged lower pulmonary vein and in left atrium of the heart an hourglass - shaped structure with dimensions 5.4  1.6 cm .
the results of laboratory tests of serum revealed the elevation of d - dimers ( 791 ng / ml ) and c - reactive protein concentration ( 37 mg / l ) . in bronchofiberoscopy
the additional longitudinal echo ranging from right pulmonary vein ostia to the mouth of mitral valve was recorded 
b ) the loss of contrast in the left atrium and thickening of the pulmonary vein .
after cardiothoracic consultation the patient was qualified for surgery . in the first stage sternotomy with extracorporeal circulation was performed .
we incised the left heart atrium and revealed a pale pink tumour , which we removed completely from the atrium and from the final section of the right lower pulmonary vein . in intraoperative cytology of the tumour imprints the pathologist found non - small cell lung carcinoma cells .
we decided to perform a right - sided thoracotomy in the second stage with right lower lung lobectomy and mediastinal lymphadenectomy .
2c the incised right pulmonary vein is shown with its wall infiltration forming the beginning section of the cardiovascular part of the tumour .
a ) intracardiac part of the tumour just before the resection and ( b ) just after the resection .
c ) right lower lobe  the pulmonary vein is cut and the infiltration of the vein wall is shown .
in the final examination of the tumour the pathologist diagnosed mixed heterogeneous lung cancer ( squamous cell and non - small cell endocrine ) in stage iiia .
there are very few cases of lung cancer extension via the pulmonary vein into the left atrium of the heart [ 2 , 3 ] .
they can be diagnosed by use of transoesophageal echocardiograms , magnetic resonance imaging , and ct scan [ 1 , 3 ] . most of those tumours show rapid growth and comprise a large mass in the lung parenchyma .
resection of the intra - atrial mass seems to be a life - threatening procedure because the patient may die from cardiac inflow obstruction and sudden cardiac arrest or massive tumour embolism involving the major organs [ 2 , 4 , 5 ] .
the possibility of systemic tumour embolisation should be considered in patients with large , central tumours and particularly those that abut the pulmonary veins [ 4 , 5 ] .
computed tomography with contrast allows the detection of the spread of lung cancer through the vessels into the heart cavity .
malignant lung tumours penetrating into the cavity of the heart can be , in some cases , radically removed . in this case
, the tumour did not infiltrate the left atrium of the heart but only grew into its light through the lower pulmonary vein ( iiia  t3n1m0  stage ) .
the rapid progression of the tumour in the presented case ( the floating part of the tumour in the atrium grew 1 cm in a week , as seen by comparing ultrasound examinations of the heart ) rapid multidisciplinary collaboration of the two centres enabled fast and efficient qualification procedure .
 computed tomography is performed in every patient before lung tumour resection . 
 the presented case realises how important it is to perform this study with contrast . in a 75-year - old male we detected a tumour ingrowing from the right lung through the right lower pulmonary vein into the left atrium of the heart . 
 the patient was qualified for primary sternotomy with extracorporeal circulation and resection of the intracardiac part of the tumour . in the second stage , 
 right - sided thoracotomy was performed , and right lower lung lobectomy was done . 
 mixed heterogeneous lung cancer was diagnosed ( squamous cell and non - small cell endocrine ) in stage iiia . 
 the perioperative period was uncomplicated . 
 the patient , due to renal failure , was not eligible for adjuvant chemotherapy . 
 if the patient were qualified for lobectomy based directly on computed tomography without contrast , there would have been a high risk of perioperative death due to embolic incidents and heart failure . 
 effective multidisciplinary collaboration allowed us to avoid this sort of complication . 
Introduction
Material and methods
Results
Discussion
Conclusions
Disclosure