Primary cardiac lymphoma: initial symptoms suggestive of gastrointestinal disease.

We report a case of primary cardiac lymphoma in a patient who was not infected with human immunodeficiency virus and had symptoms suggestive of upper gastrointestinal (GI) disease. Examination revealed no GI abnormalities. Echocardiography, prompted by sudden development of congestive heart failure, revealed a large right atrial mass. Cardiac biopsy followed by staging evaluation indicated primary cardiac non-Hodgkin's lymphoma. After chemotherapy was begun, the tumor shrunk and GI symptoms resolved, suggesting an etiologic relationship by a referred pain mechanism. Unusual features of our case include the initial predominance of GI symptoms and the circumstances that led to diagnosis antemortem. The case also underscores the importance of considering intrathoracic disease in patients with upper abdominal symptomatology.