Isolated Cardiac Involvement of B-Cell Acute Lymphoblastic Leukemia Mimicking Acute Myocardial Infarction With Persistent Broad ST-Segment Elevation

A 61-year-old Japanese woman with a previous history of complete remission of precursor B-cell acute lymphoblastic leukemia for 3 years presented to our hospital with severe chest pain. Persistent broad anterior ST-segment elevation was noted on the 12-lead ECG (Figure 1A). Troponin T level was slightly elevated to 1.190 ng/mL (normal, <0.1 ng/mL). She was referred for urgent coronary angiography, which revealed no significant stenosis (Figure 2). Despite intracoronary isosorbide dinitrate administration, the ST-segment elevation did not normalize to the baseline (Figure 1B). Circulatory assistance with intra-aortic balloon pumping was required to maintain her circulation. An echocardiogram revealed a dense thick mass in the right atrioventricular groove extending into the right ventricular free wall, left ventricular wall, and pericardium (Figure 3A and online-only Data Supplement Movies IA and IB). Enhanced computed tomography imaging showed direct infiltration of an abnormal mass occupying the myocardium and pericardium, which filled the area around the root of …