The most frequent metastatic malignancies to the heart are lung and breast carcinomas, followed by lymphomas. We herein report the case of a 62-year-old man with pre-syncope, syncope episodes and atrial flutter as the main symptoms of metastatic diffuse large B cell lymphoma, from the left kidney at the right atrium (RA). Laboratory data provided remarkable elevation of LDH, beta-2 microglobulin (B2M), cardiac enzymes and inflammatory biomarkers. The echocardiography revealed multilobulated mass extending from superior vena cava (SVC) to RA, while cardiac MRI showed invasion of RA and SVC from a tumor mass. Abdominal CT scan exhibited global enlargement, with total disorganization of renal architecture. The clinical presentation of cardiac lymphoma usually is nonspecific, going from the absence of symptoms, to heart failure, pericardial effusion or arrhythmias. Primary or secondary lymphoma should be kept in mind in patients presenting with symptomatic right-sided inflow lesions, pre-syncope, syncope episodes and arrhythmias. The elevated LDH and B2M levels, as well as high ratios of myocardial enzymes, would be considered alarming signs of cardiac involvement, as early diagnosis may be lifesaving and a chance for durable remissions or even cure.
展开▼
