Biatrial Intracardiac Mass in a Woman With a History of Lymphoma

A woman in her 60s in remission following successful combination chemotherapy for Burkitt lymphoma 8 years previously presented with dyspnea, fatigue, general malaise, presyncope, and unrevealing findings on physical examination.

This transesophageal echocardiography video (midesophageal 4-chamber view) shows a large echogenic mass on the inferior aspect of the interatrial septum with infiltration of the coronary sinus, anterior mitral valve annulus, and aortic root. The mass protruded into the left ventricular outflow tract without causing valvular obstruction.

The patient underwent transcatheter endomyocardial biopsy with biopsy of accompanying nasal septal and endobronchial lesions, which showed chronic inflammatory infiltrate with no evidence for malignancy. Immunohistochemistry analyses confirmed a large number of IgG4+ plasma cells consistent with IgG4–related disease (IgG4-RD).

She was treated with high-dose prednisone and rituximab with significant regression of the cardiac and other lesions.

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