Article Details

Background: Lymphoblastic lymphoma (LBL) is the second most common type of non-Hodgkin lymphoma (NHL) in childhood and adolescence, accounting for 25–35% of all cases. The majority, 70–80%, is of T-lymphoblastic origin, while 20–25% arises from B lymphoblasts. It is characterized by a large mediastinal mass with less than 25% bone marrow involvement. Most patients present with a cough, dyspnea, or chest pain, which is incidentally detected by a chest X-ray. Extracardiac compression of cardiac and mediastinal structures can occur, causing variable clinical presentation according to a structure being compressed, such as myocardial infarction.

Case presentation: We report a case of T-cell lymphoma, which was initially suspected by a chest X-ray and CTA, in a 31-year-old male who presented in the emergency room for severe chest pain and had a history of smoking. An ECG revealed a STEMI of the inferior myocardial wall. Transthoracic echocardiography showed circumferential pericardial effusion of 5mm, and CT aortography revealed an extensive and dense large soft tissue mass (measuring 85 x 105 x 115mm), which had contact with the coronary LAD artery. Coronary angiography revealed medial LAD stenosis of about 50% stenosis, which was mostly due to compression outside the vessel wall. A thymic carcinoma was confirmed by biopsy and the patient received radiotherapy (GMALL protocol). The further evaluation and follow up for 90 days was uneventful.

Conclusion: T-type lymphoblastic lymphoma can present as inferior wall myocardial infarction. Extra care should be taken on extra cardiac causes of myocardial infarction.

Keywords: Chest pain; Mediastinal mass; Thymic carcinoma, Lymphoblastic lymphoma; Case report