Recurrent Hodgkin's disease manifesting roentgenographically as a pleural mass.

the apex even without vasoactive maneuvers. On follow-up clinic visits two weeks and three months after discharge, the patient felt quite well, and auscultation of the heart revealed prominent late systolic click but no murmur. However, a late systolic murmur could again be precipitated by isometric exercise. DIscussIoN Until the past few years, a late systolic murmur at the apex, preceded by a mid or late systolic click, was assumed to be innocent or extracardiac in origin. However , many recent studies in these patients have demonstrated late systolic mitral regurgitation in association with prolapse or ballooning of the mitral leaflets, usually the posterior leaflet into the left atrium, " 2'5'8 and intra-cardiac phonocatheter studies have localized the click and murmur to the region of the mitral valve and left atrium.3'4 One of the complications of this syndrome described in the literature is that of subacute bacterial endocar-ditis, and instances of bacterial endocarditis have been reported in patients with a late systolic murmur, with or without a systolic click.. " However, to our knowledge, only one case of subacute bacterial endocarditis has been reported in a patient presenting only with a systolic, nonejection click without an associated murmur.6 The patient presented previously by LeBauer et al6was strikingly similar to ours. Both presented with an erythematous, tender area near the ankle, and they both had normal results of cardiac examination except for a nonejection systolic click. Both their patients and ours developed a late systolic murmur during the course of treatment for endocarditis. This case is presented to emphasize the necessity for prophylaxis against endocarditis not only in those patients with both a nonejection systolic click and late systolic murmur but also in those patients with an isolated , nonejection, late systolic click. REFERENCES 1 Barlow JB, Bosman LK: Aneurysmal protrusion of the posterior leaflet of the mitral valve: An ausculatory-elec-trocardiographic syndrome. A transseptal intracardiac phonocardiographic analysis. Am 5 Barlow JB, Bossman CK, Pocock WA, et al: Late systolic murmurs and non-ejection (" mid-late ") systolic clicks. An analysis of 90 patients. 8 Jeresaty RM: The syndrome associated with mid-systolic click and/or late systolic murmur. Analysis of 32 cases. Two cases of pleural-based Hodgkin's disease without antecedent or coincedent mediastinal adenopathy or parenchymni involvement are presented. This entity has not previously been reported. The occurrence of a pleural-based density in a patient with known Hodgkin's disease even without mediastinal or parenchymal …