Patel S, Mohammed M, Gorgis S, Zakhour S, Aurora L, Bhasin S, and Parikh S. PRIMARY CARDIAC BURKITT LYMPHOMA PRESENTING WITH ABDOMINAL PAIN. Journal of the American College of Cardiology 2021; 77(18):2672.
Journal of the American College of Cardiology
Background: Primary cardiac lymphomas are rare, carry high mortality rates and are often due to aggressive B cell lymphomas, including Burkitt Lymphoma (BL). BL is rare in the immunocompetent though more prevalent among AIDS patients.
Case: A 41yo man with a history of alcohol abuse presented with 1 month of B-symptoms and abdominal pain. Initial labs found a positive HIV-1 antibody, elevated viral load and low CD4 count. CT chest and abdomen on arrival revealed a large infiltrating lobulated right atrial mass (RAM) (Figure 1A).
Decision-making: Cardiac masses are often due to metastatic disease and warrant evaluation for extra-cardiac origin. TTE, TEE (Figures 1B & 1C) and cardiac magnetic resonance imaging identified a 2.8cm subcarinal lymph node and found the RAM to be infiltrating the inter-atrial septum, partially surrounding the pulmonary veins, obstructing the superior vena cava and extending to the aortic root (Figure 1D). Cytology of the subcarinal lymph node biopsy was consistent with BL. Highly active anti-retroviral therapy and chemotherapy were initiated. CT chest after 1 treatment cycle showed a marked reduction in RAM size (Figure 1E).
Conclusion: Our case underscores the central role of advanced imaging in the evaluation of cardiac masses by identifying a malignant etiology, staging, identifying a target for pathologic diagnosis and monitoring treatment response. Early use of multimodality imaging for cardiac masses in the HIV population allows for timely use of lifesaving therapies.