Symphony of crossfire: Aneurysm, dual vessel occlusion, and lymphoma’s hypercoagulable crescendo a case report

Abstract

Occult asymptomatic myocardial infarction in patients with malignancy (lymphoma), advanced age, and multiple comorbidities may present atypically, complicating the diagnosis of presumed recurrent infarction. We present a highly complex case of a 66-year-old male with lymphoma and multiple comorbidities who collapsed with diffuse ST-segment elevation on electrocardiography (ECG). The diagnostic challenge required concurrent percutaneous coronary intervention (PCI) and echocardiography to identify the thrombotic occlusions in two coronary vessels. Empirical placement of stents in the right coronary artery and left circumflex artery resolved the acute occlusions, while retrograde imaging revealed a previously undiagnosed anteroapical left ventricular aneurysm. This case underscores the importance of integrating multimodal imaging in oncological patients with atypical cardiovascular presentations.