CTICasesExtramedullary AML Recurrence in the Interatrial Septum
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Imaging findings
Bilateral pleural effusions (chronic, attributed to graft-versus-host disease). An evolving soft tissue attenuation mass in the interatrial septum, which was not present two years prior (was fat then). PET showed a focus of activity in the interatrial septum, but also heterogeneous myocardial uptake. Cardiac MRI showed soft tissue surrounding the interatrial septum and delayed enhancement, as well as patchy enhancement in the LV. The mass significantly progressed over several weeks. Pleural effusion tap confirmed blasts, and bone marrow was negative for recurrence.
Key takeaways
The interatrial septum can be a "sanctuary" for extramedullary lymphoma and leukemia. Progressive soft tissue mass in the interatrial septum in a patient with a history of AML and GvHD flare, even with negative bone marrow, should raise high suspicion for extramedullary recurrence. The presence of blasts in the pleural effusion confirmed the diagnosis. Cardiac involvement of AML can be challenging to diagnose, but imaging can provide crucial clues.
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