Rosas Daniel, Yepes Isaac, Tschanz Jacqueline, Wariboko Minaba, Sandoval-Sus Jose D
Internal Medicine, Memorial Healthcare, Sunrise, USA.
Internal Medicine, Memorial Hospital West Healthcare System, Pembroke Pines, USA.
Cureus. 2020 Apr 17;12(4):e7704. doi: 10.7759/cureus.7704.
We present a case of a 59 year old female patient that presented with exertional chest pain and palpitations. A workup revealed an EKG with signs of right ventricular hypertrophy, a high Pro-BNP and 3 sets of negative troponin levels. A CT scan of the chest was negative for pulmonary embolism (PE) but revealed a nodular thickening of the atrial septum with right atrial extension encasing the right coronary artery. A CT scan of the abdomen and pelvis with IV contrast revealed several nodular foci scattered in the subcutaneous fat of the abdominal wall bilaterally. An initial transthoracic echocardiogram (TTE) revealed thickening of the interatrial septum with a mass protruding from the interatrial septum into the left atrium and a secondary pedunculated mass protruding from the interatrial septum into the right atrium with significant obstruction within the right atrium. An ultrasound-guided biopsy of the soft tissue nodule in the right anterior abdominal wall and subcutaneous tissue showed the classical starry sky appearance pattern confirmed later to be a Burkitt lymphoma. The patient received chemotherapy and follow up CT of the abdomen and pelvis reported resolution of the soft tissue density involving the partially visualized portions of the heart. Although rare, cardiac lymphomas should be considered in the differential diagnosis of patients with identified cardiac masses. As the initial presentation is usually composed by non-specific symptoms, a detailed clinical history can identify certain constitutional symptoms and a thorough physical exam can lead to the suspicion of cardiac structural pathology prompting the need for the appropriate chest imaging. Further characterization may need TTE or TEE which are more sensitive and specific due to the tri-dimensional and temporal quality of the imaging. Appropriate biopsy with pathology and molecular studies are of utmost importance in making an accurate diagnosis in order to select the best management for this highly aggressive malignancy.
我们报告一例59岁女性患者，其出现劳力性胸痛和心悸。检查发现心电图有右心室肥大迹象、脑钠肽前体水平升高且3次肌钙蛋白水平均为阴性。胸部CT扫描未发现肺栓塞（PE），但显示房间隔结节状增厚并向右心房延伸，包绕右冠状动脉。经静脉注射造影剂的腹部和盆腔CT扫描显示双侧腹壁皮下脂肪中有多个结节状病灶。最初的经胸超声心动图（TTE）显示房间隔增厚，有一肿块从房间隔突入左心房，还有一个带蒂的肿块从房间隔突入右心房，导致右心房内明显梗阻。对右前腹壁和皮下组织的软组织结节进行超声引导下活检，显示出典型的星空样外观模式，后来证实为伯基特淋巴瘤。患者接受了化疗，腹部和盆腔的后续CT报告显示累及心脏部分可见区域的软组织密度影已消退。尽管罕见，但在诊断有明确心脏肿块的患者时，应考虑心脏淋巴瘤。由于最初的表现通常由非特异性症状组成，详细的临床病史可识别某些全身症状，全面的体格检查可引发对心脏结构病理的怀疑，从而促使进行适当的胸部影像学检查。进一步的特征性检查可能需要TTE或TEE，由于其成像的三维和时间特性，它们更敏感和特异。适当的病理活检及分子研究对于准确诊断至关重要，以便为这种高度侵袭性的恶性肿瘤选择最佳治疗方案。
