Author + information
- Received November 23, 2010
- Revision received December 2, 2010
- Accepted January 3, 2011
- Published online October 18, 2011.
- Moritz C. Wyler von Ballmoos, MD, MPH,
- Saqib Masroor, MD, MHS,
- Ghulam Murtaza, MD,
- Jose Franco, MD,
- Mario Gasparri, MD and
- Jason C. Rubenstein, MD
A 67-year-old male patient with a history of liver transplant, autoimmune pancreatitis, primary sclerosing cholangitis, and Mikulicz disease presented with fatigue, dyspnea, and chest pain. Cardiac magnetic resonance (CMR) imaging revealed a large mass surrounding the distal left main, left anterior descending, and circumflex coronary arteries. Three-chamber (A, Online Video 1) and short-axis (B, Online Video 2) steady-state free-precession (SSFP) CMR images demonstrate the tumor (arrowheads) at baseline (diameter: 80 × 52 mm).
Biopsy of the mass revealed hyper-immunoglobulin G (IgG) disease. This is an IgG4-positive multifocal lymphoproliferative syndrome characterized by fibrosis, dense lymphoplastic infiltrates, obliterative vasculitis, and elevated serum IgG4 levels and responsive to chemotherapy with glucocorticosteroids. Three-chamber (C, Online Video 3) and short-axis SSFP CMR images (D, Online Video 4) are shown after a 3-month course of prednisone (mass diameter: 64 × 44 mm).
- Received November 23, 2010.
- Revision received December 2, 2010.
- Accepted January 3, 2011.
- American College of Cardiology Foundation