PMC3658218_01
Electrocardiogram revealing complete atrioventricular block with junctional escape rhythm (arrows).
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Electrocardiogram revealed complete atrioventricular block with junctional escape rhythm (Figure 1).
An ultrasonogram showing a massive infiltrative thickening of the posterior aspect of the left atrial septum and interatrial septum.
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Before a permanent pacemaker was implanted, transthoracic echocardiography revealed a massive infiltrative thickening of the inferior aspect of the left atrial septum and interatrial septum mimic thrombus (Figure 2).
Transesophageal echocardiography showing tumor masses attached to the interatrial septum and protruding into both atrial cavities.
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Ensuing transesophageal echocardiography revealed a mass attached to the interatrial septum and protruding into both atrial cavities (Figure 3).
A multislice computed tomogram showing a bulky infiltrative mass about 8.62 cm x 6.45 cm x 9 cm at posterior-lateral and inferior aspect of the left atrium with invasion to myocardium, the interatrial septum, tricuspid valve, right atrium, pericardium, left hilar region, and left pleura (arrow).
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Multislice computed tomography (MSCT) revealed a bulky infiltrative mass 8.62 cm x 6.45 cm x 9 cm at the posterior-lateral and inferior aspect of the left atrium with invasion to myocardium, the interatrial septum, tricuspid valve, right atrium, pericardium, left hilar region and left pleura (Figure 4).
FDG-PET revealed remarkably increased glucose metabolism in the RA, interatrial septum, LA, and in a tumor mass protruding from the posterior aspect of pericardium.. Abbreviation: FDG-PET, F-labeled 2-deoxyglucose positron electric tomography.
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However, the result showed no abnormal radiotracer uptake in the pleura and lymph nodes (Figure 5). T cells, but negative for cytokeratin, S-100, chromogranin, CD56, desmin, FLI-1, and CD34 (Figure 5). The patient was thus referred to a hematologist for chemotherapy with regimens of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) for 3 courses, with rituximab for 2 courses.