A 29-year-old man was admitted with new onset atrial fibrillation (figure 1).
For UK healthcare professionals only
One year previously he had been treated with six cycles of chemotherapy for aplastic large cell lymphoma. He had a pyrexia (38.5oC), elevated C-reactive protein (14.6 mg/L) and low haemoglobin (10.8 g/dL). As part of a screen for infection, echocardiography was performed to exclude endocarditis (figure 2), but revealed a large intra-atrial mass. Cardiac magnetic resonance imaging (MRI) (figure 3) appearance was consistent with a lymphoma tumour. Fine-needle aspiration of an enlarged supra-clavicular node showed evidence of relapsed lymphoma. Further treatment with chemotherapy resulted in complete resolution (figure 4) of the intra-atrial mass, of his symptoms, and in restoration of sinus rhythm.