Intracardiac mass from Burkitt's lymphoma in an immunocompromised patient: a very rare form of presentation.

Vilaça A, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-221001 Description A 64-year-old man presented at the emergency department for lipothymia, nausea and palpitations for a few days duration. He was diagnosed with HIV infection 10 years ago. He never was compliant with his antiretroviral therapy (ART). Pertinent physical findings included tachycardia and tachypnoea. Laboratory work-up revealed elevated troponin 0.30 ng/mL, elevated brain natriuretic peptide (PBNP) 4435 pg/mL and elevated creatinine 1.8 mg/dL with urea in normal range (40 mg/dL). Blood exams revealed CD4+ T cell count of 47 cells/ μL with HIV RNA copies of 213 025/mL. The chest CT scan showed thickening of the lateral slope of the right cardiac cavities and atrioventricular septum, with involvement of the pericardial cavity; three pericardiac ganglia close to the right atrium, the largest with 16 mm (figure 1A). The pelvic CT scan showed kidneys with small hyperdensal, peripheral foci, predominantly on the right (figure 1B). Transthoracic echocardiography demonstrated heterogeneous ecodense mass centred on the lateral wall of the right atrium, extending inferiorly to the atrioventricular sulcus and basal free wall of the right ventricle, with invasion of the posterior tricuspid valve leaflet (7.3×4.4×4.8 mm), extending to the pericardial space. A cardiac MRI revealed a second intramyocardial nodular lesion in the apical