Primary Cardiac Lymphoma with Complete Atrioventricular Block

Cardiac symptoms as an initial presentation of malignant lymphoma are rarely seen. We report a 42-year-old male patient of primary cardiac lymphoma originating in the left atrium with episodes of syncope. Complete atrioventricular (AV) block was found by electrocardiography, and the patient was admitted for pacemaker implantation. Before permanent pacemaker implantation, transthoracic echocardiography (TTE) revealed a massive infiltrative thickening in the left atrial and interatrial septal walls which initially mimicked an intra-atrial thrombus. After a series of imaging studies, including TTE and transesophageal echocardiography (TEE), multislice computed tomography (MSCT), fluoroscopic-guided endomyocardial tissue biopsy, and positron electric tomography (PET), large B cell type primary cardiac lymphoma was diagnosed. The patient died two months later in spite of epicardial permanent pacemaker implantation and two courses of chemotherapy treatment.