case_images: PMC11683414_01
case_images: ECG demonstrating complete heart block at the time of first presentation.
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case_images: PMC11683414_01_ytae663f1.jpg
case_images: ytae663-F1
case_images: Initial ECG showed complete heart block (Figure 1); however, urgent pacemaker (PM) implantation was not implanted due to a junction rhythm of 50 b.p.m., and further work-up performed.
case_images: Echocardiography. (A and B) Transthoracic echocardiography suspecting thickening of left heart and pericardial effusion in (A) parasternal long-axis view and in (B) apical four-chamber view (white arrow). (C-F) Transoesophageal echocardiography suggesting infiltrative character in (C) mid-oesophageal long-axis view, in (D) mid-oesophageal aortic valve long-axis view, in (E) two-chamber view and (F) four-chamber view (white arrow). LA, left atrium; LV, left ventricle.
case_images: ytae663f2.jpg
case_images: PMC11683414_01_ytae663f2.jpg
case_images: ytae663-F2
case_images: Transoesophageal echocardiography (TOE) confirmed the presence of intramyocardial masses, which also infiltrated the region of the atrioventricular and aortic roots without valve involvement (Figure 2C-F).
case_images: Magnetic resonance imaging. (A-F) Magnetic resonance imaging demonstrating the infiltrative mass in steady-state free precession in (A) four-chamber view and in (B) in short axis; hyperintensity on T2-weighted short-tau inversion recovery in (C) four-chamber view and in (D) short axis; inhomogeneous hyperenhancement in phase-sensitive inversion recovery images in (E) four-chamber view and in (F) short axis (white arrow).
case_images: ytae663f3.jpg
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case_images: Extensive enhancement of the mass was observed in the LGE sequences (Figure 3).
case_images: Computer tomography. (A and B) Coronary computer tomography revealing extent of mass and encasement of coronary arteries in (A and B) axial four-chamber views (white arrow). (C and D) Staging computer tomography detecting enlarged lymph nodes in (C) axial mediastinal window and in (D) axial subdiaphragmatic window (white arrow).
case_images: ytae663f4.jpg
case_images: PMC11683414_01_ytae663f4.jpg
case_images: ytae663-F4
case_images: Large vessels and coronary arteries were encased by the mass (Figure 4A and B).