Cardiac rupture due to metastases from a carcinoma of the antrum.

A 70-vear-old White Russian Jewish iian began to experience pain in the region of the right upper molar teeth late in March 1957. The first right upper molar tooth was removed shortly thereafter. The pain persisted, however, and the wound failed to heal properly. There was progressive swelling of the right upper jaw, as well as a foul-smnelling sanguineous oozing from the site of extraction. Biopsy of the area revealed undifferentiated anaplastic carcinoma. He entered the Beth Israel Hospital on May 10, 1957. The patient had had an episode of ainebic hepatitis in 1939 and an acute miiyocardial infarction in October 1954. Physical examination on admission revealed swelling of the right side of the face, a neerotic area in the right upper alveolus, and a firm right submandibular node of moderate size. The blood pressure was 120/70. Roentgenogranis of the skull and paranasal sinuses (fig. 1) showed the right antral cavity almost totally obscured by aln irregular soft-tissue mass extending into the adjacent nasal cavity. There was sonie destruction of the medial and lateral walls of the antrum as well as of the floor of the orbit. Chest and cervical spine, examined by x-ray, were within normal limits. An electrocardiogram revealed evidence of old anterolateral infarction (fig. 2, left). The hemnoglobin level was 12.2 Gni. per cent, the lhemiiatocrit value was 37 per cent, and the white-cell count was 12,500 per mnl. A urinalysis and blood nonprotein nitrogen determination were within normnal limits. In preparation for a course of supervoltage x-ray therapy the right preimolar and molar teeth were extracted, and an antral-oral