This Article Full Text Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Binder, J. Articles by Schwarz, S. Search for Related Content PubMed PubMed Citation Articles by Binder, J. Articles by Schwarz, S. Related Collections Related Article

(Circulation. 2004;110:e451-e452.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Right Atrial Primary Cardiac Lymphoma Presenting With Stroke

Johannes Binder, MD; Stefan Pfleger, MD; Stefan Schwarz, MD

From the Department of Neurology (J.B., S.S.) and the Department of Medicine I (Cardiology, Angiology, and Pneumology) (S.P.), Universitätsklinikum Mannheim, University of Heidelberg, Germany.

Correspondence to Dr Johannes Binder, Department of Neurology, Universitätsklinikum Mannheim, Theodor Kutzer Ufer 1-3, D-68135 Mannheim, Germany. Email j.binder@neuro.ma.uni-heidelberg.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

An immunocompetent 79-year-old man presented with acute dysarthria and hemiparesis on the left side. The cranial CT revealed the typical findings of a middle cerebral artery territory infarction of embolic origin, likely from previously unknown nonvalvular atrial fibrillation. The results of the duplex ultrasound of the carotid arteries were normal. Transesophageal echocardiography, however, showed a right atrial tumor, which suggested either thrombus or myxoma (Figure 1A, Movie I). No evidence of a thrombus or spontaneous echo contrast was observed in the left atrium; the mean left atrial appendage peak emptying velocity was 0.35 m/s. Moreover, few microbubbles appeared in the left atrium, although only after >3 heart cycles (Figure 1B, Movie II). In combination with the findings from contrast transcranial Doppler ultrasound, which showed 3 bubbles within 20 seconds, some evidence of right-to-left shunting was noted, although the formal echocardiographic criteria of a patent foramen ovale were not fulfilled. The thoracic CT showed a right atrial tumor extending into the superior vena cava (VCS), as well as pericardial and right-sided pleural effusions (Figure 2). After surgical removal of the tumor the histological examination surprisingly revealed a primary cardiac non-Hodgkin lymphoma (PCL). The immunohistochemical classification showed a diffuse large B cell lymphoma with high immunoglobulin M expression. An extensive diagnostic work-up yielded no evidence of an extracardial lymphoma manifestation. The patient refused all therapy and died 6 weeks later at home.

View larger version (69K): [in this window] [in a new window]   Figure 1. Transesophageal echocardiography demonstrates PCL in right atrium extending into VCS. (A) RA . . . [Full Text of this Article]

Related Article:

Circulation 2004 110: 2551. [Extract] [Full Text]

This article has been cited by other articles:

				A. Motto, P. Ballo, D. Zito, L. Cadenotti, M. Moroni, P. Dessanti, and F. Fedeli Primary Cardiac Lymphoma Presenting As Sick Sinus Syndrome J. Clin. Oncol., December 20, 2008; 26(36): 6003 - 6005. [Full Text] [PDF]