When Chest Pain Isn't What It Seems: A Case of Cardiac Lymphoma.

Primary cardiac lymphoma (PCL) is an exceedingly rare malignancy, often presenting with heart failure or arrhythmias. This case report describes a 61-year-old male with a history of diabetes, hypertension, and ischemic heart disease who presented with symptoms mimicking acute coronary syndrome (ACS). Despite significant stenosis in the left anterior descending artery (LAD), advanced imaging, including cardiovascular magnetic resonance (CMR) and positron emission tomography (PET) scan, revealed a large infiltrative mass consistent with PCL. The patient was diagnosed with high-grade B-cell lymphoma but unfortunately succumbed to rapid disease progression before initiating chemotherapy. This case emphasizes the importance of considering alternative diagnoses in atypical ACS presentations and highlights the critical role of multimodal imaging in accurately diagnosing rare cardiac tumors. Early diagnosis and prompt treatment are essential for improving outcomes in PCL, an aggressive malignancy with limited treatment options. The case also underscores the need for heightened clinical awareness and further research into the pathophysiology and management of PCL.