Resolution of an intracardiac mass with chemotherapy

Abstract

Right atrial intracardiac tumours are uncommonly seen during echocardiography. Our patient presented with primary mediastinal large B-cell lymphoma with intracardiac involvement. The tumour was seen by echocardiography and the extent of the tumour was defined by CT scan of the chest. Following chemotherapy directed to her specific tumour cell type, there was complete resolution of the intracardiac mass.

Figure 1

Chest x-ray showing mediastinal widening (arrows).

Figure 2

Two-dimensional echocardiogram in the apical four chamber view showing the right atrial mass measuring 37×30 mm (arrow). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 3

(A) Coronal section from the CT scan of the chest showing a large anterior mediastinal mass completely obscuring the superior vena cava and extending into the right atrium (broad arrow). The mediastinal mass is outlined by white arrows. Ao, aorta; LV, left ventricle; RV, right ventricle. (B): Horizontal section from the chest CT showing infiltration of the right atrium by the lymphoma. (C): Coronal section more anteriorly than (A) showing large contrast filled collaterals arising from the right subclavian vein toward the lower veins in the chest.

Figure 4

Micrograph showing a diffuse growth pattern, comprising large cells with polymorphic nuclei that have an abundant rim of clear cytoplasm and fibrosis (arrow) compartmentalising the cells which is characteristic feature of primary mediastinal large B-cell lymphoma.

Figure 5

(A) Two-dimensional echocardiogram in the apical four-chamber view showing complete resolution of the mass 1 month following chemotherapy.