Journal of Rare Cardiovascular Diseases

Hematological malignancies are protean in their presentations. Primary cardiac tumors are exceedingly rare, and primary cardiac leukemia presenting as an isolated mass is even rare. Here, we present a case of a young man who presented with one month history of fever and shortness of breath. His examination revealed signs of right sided heart failure. On workup he was found to have a mass in the heart on CT scan of the chest, his transthoracic echocardiography showed an isolated right atrioventricular groove mass. Surgical biopsy confirmed it to be an extremely rare presentation of Pre B Acute Lymphoblastic leukemia(ALL). Though the patient underwent surgical excision of the lesion yet, he developed bone marrow leukemic involvement confirmed by bone marrow biopsy and died of overwhelming sepsis secondary to pancytopenia. This case highlights that hematological malignancies can present as cardiac masses and should be considered during workup of patients presenting with chronic fever and right sided heart failure.

cardiac tumor; pre‐B‐cell lymphoblastic leukemia; echocardiography; rare cardiovascular disease

Sumners JE, Johnson WW, Ainger LE. Childhood Leukemic Heart Disease A Study of 116 Hearts of Children Dying of Leukemia. Circulation. 1969 Oct 1;40(4):575-81.

Hunkeler N, Canter CE. Antemortem diagnosis of gross cardiac metastasis in childhood leukemia: echocardiographic demonstration. Pediatr Cardiol.1990;11:225–226.

Bjorkholm M, Ost A, Biberfeld P. Myocardial rupture with cardiac tamponade as a lethal early manifestation of acute myeloblastic leukemia. Cancer. 1982;50:1867–1869.

Wiernik PH, Sutherland JC, Stechmiller BK, Wolff J. Clinically significant cardiac infiltration in acute leukemia, lymphocytic lymphoma, and plasma cell myeloma. Medical and pediatric oncology. 1976 Jan 1;2(1):75-85.

Hori T, Suzuki N, Mizue N, Hatakeyama N, Takamuro M, Tsutsumi H. Relapse of T‐cell all after stem cell transplant presenting as hypertrophic cardiomyopathy: The value of non‐invasive diagnostic imaging in detecting cardiac leukemia. Pediatric blood & cancer. 2006 Jan 1;46(1):108-11.

Hardikar A, Shekar P, Stubberfield J, Craddock DR, Bignold LP. Cardiac involvement in a case of acute lymphoblastic leukemia.The Annals of thoracic surgery. 2002 Apr 30;73(4):1310-2.

Wright TL, Bardy PG, Disney P, Moore S, Horvath N. Isolated cardiac recurrence of acute lymphoblastic leukemia characterized by t (11; 19) two years after unrelated allogeneic bone marrow transplantation. Cancer genetics and cytogenetics. 2002 Sep 30;137(2):146-9.

Werner RA, Rudelius M, Thurner A, Higuchi T, Lapa C. Cardiac Manifestation of Acute Lymphoblastic Leukemia. Clinical nuclear medicine. 2016 Jul 1;41(7):570-1.

Chang K, Kim DY, Lee KH, Huh J, Kang JW, Shin DY, Kim DH. An isolated cardiac relapse after allogeneic hematopoietic stem cell transplantation for acute lymphoblastic leukemia.The Korean journal of internal medicine.2016 Feb 2.

Kahwash R, Rugg SS, Smith MD. Relapsing B-cell lymphoblastic leukemia in an adult presenting as an infiltrative cardiac mass with tamponade.Journal of the American Society of Echocardiography. 2007 Nov 30;20(11):1319-e1

Kakefuda Y, Sato A, Hoshi T, Ishizu T, Tada H, Satomi K, Morishita Y, Okoshi Y, Tokunaga C, Sakakibara Y, Aonuma K. Isolated Cardiac Involvement of B-Cell Acute Lymphoblastic Leukemia Mimicking Acute Myocardial Infarction With Persistent Broad ST-Segment Elevation. Circulation. 2012 Jun 5;125(22):e979-82.

Bekkers BC, Denarié BJ, Bos GM. Massive cardiac involvement in acute lymphatic leukemia. Heart. 2004 Mar;90(3):354.

Barbaric D, Holley D, Lau KC, McCowage G. It is ALL in the heart: a patient with acute lymphoblastic leukemia and cardiac infiltration at time of diagnosis. Leukemia & lymphoma. 2002 Jan 1;43(12):2417-9.