ABSTRACT
BACKGROUND: Ventricular cystic masses are uncommon. Elucidating the cause is essential for early directed therapy and prevention of complications. We present two cases of ventricular cystic masses, one in each ventricle, after myocardial infarction (MI) and ventricular septal rupture (VSR), respectively. CASE SUMMARY: Patient 1 is a 58-year-old male with left brachio-facial stroke and evolved anterior MI. A left ventricular (LV) cystic thrombus was seen on transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) imaging. He was started on anticoagulation with reduction in thrombus size 11 days later. Patient 2 is a 67-year-old male with evolved anterior MI, severe LV systolic dysfunction, and normal right ventricular (RV) function. He was readmitted two weeks later with fever, heart failure, Streptococcus agalactiae bacteraemia, and septic pulmonary emboli. Transthoracic echocardiogram showed biventricular systolic dysfunction and a RV cystic mass associated with a partial VSR. He was treated with anticoagulation and antibiotics. Repeat TTE 5 weeks later revealed near resolution of the cystic mass and complete VSR. Cardiac magnetic resonance confirmed these findings and also showed a localized mid-septal transmural infarction at the VSR site. He underwent percutaneous coronary intervention to the left anterior descending and circumflex arteries, and percutaneous VSR closure with a muscular ventricular septal defect device later. DISCUSSION: Our two cases demonstrate that ventricular thrombi can present as cystic masses after MI and VSRs. Infectious, vascular, or oncogenic causes should be considered in the appropriate clinical context. Early diagnosis and treatment is essential to prevent embolic complications, and secondary infection.
ABSTRACT
BACKGROUND: Primary cardiac lymphoma is defined as extranodal lymphoma involving the heart or pericardium. Common presentations of human immunodeficiency virus (HIV)-associated cardiac lymphoma include heart failure, cardiac tamponade, and rhythm abnormalities. Arrhythmia is an uncommon presentation and treatment in young HIV patients is particularly challenging. We present a unique case of primary cardiac lymphoma in an HIV patient presenting with both symptomatic tachy- and bradyarrhythmias. CASE SUMMARY: A 27-year-old man presented with intermittent palpitations and chest pain for 2 weeks. He has a significant past history of advanced HIV. He was noted to have complete heart block on cardiac monitoring. Imaging showed a large mass in the right atrioventricular (AV) groove extending into the myocardium, associated with a moderate pericardial effusion. During his stay, he developed symptomatic tachy-brady arrhythmias, with intermittent junctional tachycardia, supraventricular tachycardia, and complete AV block. After a multidisciplinary team discussion, endomyocardial biopsy was performed under fluoroscopy and transthoracic echocardiography guidance. Histology from the interventricular septum was consistent with Epstein-Barr virus positive B-cell lymphoma. The patient was subsequently transferred to a tertiary hospital with cardiothoracic surgical support to initiate chemotherapy. DISCUSSION: To our knowledge, our patient is the first reported case of HIV-related primary cardiac lymphoma presenting with palpitations secondary to paroxysmal supraventricular tachycardia with concomitant AV block. This case illustrates the utility of multi-modality imaging in the investigation of a cardiac mass and the importance of having a high index of suspicion for pathology, such as cardiac lymphoma in HIV patients complaining of apparently minor cardiac complaints.
