Sudden death following endomyocardial biopsy of cardiac metastasis from malignant melanoma

Excerpt

A 74 year old woman with a significant past history of right thigh melanoma, which was removed some 25 years previously but had positive inguinal nodes at the time, was admitted to hospital in heart failure. Echocardiogram demonstrated a right ventricular mass extending into the septum and impeding right ventricular filling. Tissue diagnosis was sought with a view to determining whether the mass was amenable to intervention, and to this end an endomyocardial biopsy was undertaken. Shortly thereafter the patient became hypotensive and an echocardiogram showed a large pericardial effusion. Pericardiocentesis was attempted without significant clinical improvement and the patient died a short time later. As the death had occurred in the setting of a medical procedure, it was reported to the State Coroner who directed a medico legal autopsy be performed. …