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case_images: Third-degree heart block with small QRS complexes on electrocardiogram.
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case_images: Electrocardiogram (ECG) on admission revealed a complete heart block with small QRS complexes (Figure 1).
case_images: Transthoracic echo shows a large circumferential pericardial effusion measuring 2.7 cm at its largest, with evidence of right chamber collapse.
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case_images: A large circumferential pericardial effusion measuring 27 mm with evidence of right ventricular and right atrial diastolic collapse was present (Figure 2).
case_images: Lobulated soft tissue mass extending into the musculature of the right atrium and bilateral pleural effusions on computed tomography thorax.
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case_images: It measured 52 mm at its maximum diameter. (Figure 3).
case_images: Transoesophageal echocardiogram and fluoroscopy-guided endomyocardial biopsy of cardiac mass. A steerable Agilis catheter is used to position the bioptome at the anterior right atrial wall to obtain tissue sample.
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case_images: Therefore, an Agilis steerable sheath was used which allowed optimal positioning of the bioptome and biopsy of the right atrial mass (Figure 4).
case_images: Histology and immunohistology of myocardial tissue: (A) Histology shows myocardial tissue infiltrated by pleomorphic medium to large-sized lymphoid cells with round vesicular nuclei and prominent nucleoli (haematoxylin and eosin staining; x40). (B) Immunohistochemistry shows tumour cells strongly positive for CD20 (x 40). (C) Immunohistochemistry using Ki-67 shows a high proliferation index of ~70% (x 40).
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case_images: Histology of the tissue samples confirmed a diffuse large B-cell lymphoma ABC subtype (Non-Hodgkin's lymphoma) (Figure 5).