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BMJ Case Reports 2012; doi:10.1136/bcr.10.2011.4890
  • Unusual association of diseases/symptoms

Complete heart block as a complicating feature of a mediastinal lymphoma

  1. Manuel Vaz Riscado1
  1. 1Department 2, Curry Cabral’s Hospital, Lisbon, Portugal
  2. 2Haematology Department, Portuguese Institute of Oncology, Lisbon, Portugal
  1. Correspondence to Dr Vanda Cristina Jorge, vandacristinajorge{at}gmail.com

Summary

Malignant lymphomas represent about 9% of cardiac neoplasms. Despite its life-threatening nature, the cardiac manifestations are often subclinical. In about 20% of deaths from lymphoma, cardiac involvement is found only in autopsy. The authors present the case of a 77-year-old female admitted due to intense back pain, vomiting, generalised pruritus, fatigue and weight loss. She had a personal history of hypertension and breast cancer was noted 10 years before admission. The thoracoabdominopelvic CT showed a mass in the left atrium with extension to the right atrium and inferior vena cava, and a paravertebral mass at D10-D11 with invasion of the spinal canal and hepatic hilum. The transthoracic paravertebral mass biopsy was compatible with a diffuse large B cell lymphoma. The patient developed a complete atrioventricular block, with haemodynamic instability, requiring urgent chemoreduction of the paracardiac mass and implantation of an epicardial pacemaker.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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