An SO-year-old man who initially presented with a left hemiparesis rapidly developed right-sided heart failure and died. Although an echocardiogram suggested the presence of a tumor, the diagnosis of a primary cardiac lymphoma was made only at autopsy. The tumor involved a leaflet of the tricuspid valve, a finding not previously reported in the literature. In 1977, the Armed Forces Institute of Pathology defined a primary malignant lymphoma of the heart as that involving only the heart and pericardium. Many reports of primary cardiac malignant lymphomas have been published, however, most of which mention the presence of metastases. We have reviewed the world literature to determine the number of actual cases of primary malignant lymphoma of the heart. Only 15 reported cases, including the current case, were found to meet the current criteria. Accepted for publication December 26, 1988. medications), hyperuricemia (treated with allopurinol), supraventricular tachycardia, and a normochromic normocytic anemia. Admission physical examination revealed a pulse of 100 beats per minute, respirations of 22 per minute, and a blood pressure of 160/100 mm Hg. He was afebrile. His head and eyes were deviated to the right, with intact doll's eyes and a questionable left field cut. He had a left central fifth and seventh nerve deficit. The chest was symmetrical without bony abnormality. There were bibasilar rales without evidence of consolidation or wheezes.A cardiac examination revealed a rocking motion on palpation with a summation gallop and a holosystolic murmur at the left lower sternal border. Carotid pulses were 2+ without bruits. There was no jugular venous distention. Abdominal, genitourinary, and rectal examination were unremarkable. The extremities were without clubbing, cyanosis, or edema. Motor examination revealed 5/5 strength on the right side. On the left, there was 3/5 strength in both upper and lower extremities, and muscle development was appropriate for age. There was increased muscle tone ofthe left upper and lower extremities. His reflexes were brisk and symmetric. There were crossed adductor responses bilaterally as well. Coordination, station, and gait were not tested.The admission computed tomography scan (CT scan) of the head showed only moderate cortical atrophy, as seen on CT scan performed 1 year previously. An elecrocardiogram (EKG) revealed sinus tachycardia, first degree atrioventricular block, and nonspecific ST-T changes. A chest radiograph showed prominent pulmonary vasculature and blunting of the right a stovertebral angle. There was a marked increase in the sue of the heart since the most recent film was taken 1 year earlier. Liver function tests were elevated with an aspartate aminotransferase (AST) of 406 U/1 (normal, 26-88); alanine aminotransferase (ALT) of 197 U/1 (normal, 10-60), and alkaline phosphatase of 52 1
