SHM Converge Scientific Abstract ePoster Gallery-When Syncope Reveals a Malignancy: Cardiac Lymphoma in a Young Adult

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A 26-year-old previously healthy woman presented with near-syncope, exertional dyspnea, fatigue, and persistent sinus tachycardia. Initial labs and exam were unremarkable, but transthoracic echocardiogram revealed multiple intracardiac masses: two left atrial masses causing flow limitation and a large right atrial mass obstructing outflow and extending into the right ventricle. She also had a history of right tonsillar swelling two months earlier that had temporarily improved with amoxicillin and methylprednisolone.<br /><br />Further evaluation with cardiac MRI showed large bilateral atrial masses with infiltrative thickening along the atrioventricular grooves and interatrial septum. PET-CT demonstrated markedly hypermetabolic cardiac masses along with mediastinal and bilateral hilar lymphadenopathy. Biopsy of the right tonsil and mediastinal lymph nodes confirmed Epstein-Barr virus–positive, MYC-expressing, TdT-positive aggressive B-cell lymphoma with a very high proliferation index. Bone marrow biopsy was negative.<br /><br />She was started on Hyper-CVAD chemotherapy, and repeat cardiac MRI after the first cycle showed significant regression of the intracardiac masses and near-resolution of the lymphadenopathy.<br /><br />The case highlights that cardiac tumors are rare, and primary cardiac tumors are malignant in only a minority of cases. Their symptoms are often vague and nonspecific, including dyspnea, chest pain, arrhythmias, fatigue, or syncope, making diagnosis difficult. This report emphasizes that presyncope and persistent tachycardia in a young adult should not be dismissed, as they may signal an underlying malignancy. Careful history-taking, awareness of prior suspicious symptoms such as tonsillar swelling, and targeted imaging are crucial for timely diagnosis and treatment of cardiac lymphoma.

Asset Subtitle

Archana Regmi

Meta Tag

Author List Archana Regmi, George Everett, Shristi Nepal, Xiaojin Song

Category Clinical Vignettes

Concept Cardiac Mass

Concept Intracardiac Mass

Concept Syncope

Concept Cardiac Lymphoma

Concept Cardiac Tumor

Distinguished Non-Finalist

Presenter Organization AdventHealth Orlando

Presenting Author Archana Regmi

Track Adult

Keywords

cardiac lymphoma

intracardiac masses

atrial masses

persistent sinus tachycardia

near-syncope

exertional dyspnea

Epstein-Barr virus positive

aggressive B-cell lymphoma

PET-CT hypermetabolic

Hyper-CVAD chemotherapy

Cardiac Mass

Intracardiac Mass

Syncope

Cardiac Lymphoma

Cardiac Tumor