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

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 [ 18 F]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.