BiatriaL cardiac extension of Burkitt lymphoma: a case report of successful surgical correction

BACKGROUND: Primary cardiac tumors are rare, and cardiac involvement by Burkitt lymphoma is exceptionally uncommon, particularly when presenting with extensive intracavitary growth. Such tumors may rapidly lead to hemodynamic compromise due to obstruction of venous inflow and impairment of cardiac filling, often requiring urgent surgical intervention. Establishing cardiopulmonary bypass in these settings may be technically challenging, especially when conventional inferior vena cava cannulation is precluded by tumor extension. CASE PRESENTATION: We report a unique case of a 30-year-old male who presented with acute heart failure and severe hemodynamic instability caused by massive biatrial involvement of Burkitt lymphoma. Imaging revealed large intracavitary tumors extending into the inferior vena cava and pulmonary veins, resulting in near-complete obstruction of venous return. During emergency surgery, standard inferior vena cava cannulation and snaring were not feasible due to tumor invasion. To achieve adequate venous drainage and enable cardiopulmonary bypass, an unconventional technique using a cuffed endotracheal tube as a temporary inferior vena cava cannula was successfully employed. This approach allowed effective tumor debulking, restoration of intracardiac blood flow, and subsequent initiation of definitive systemic chemotherapy. Histopathological and molecular analysis confirmed Burkitt lymphoma with a high proliferative index and c-MYC gene translocation. At one-year follow-up, the patient demonstrated complete metabolic remission on ¹⁸F-FDG PET/CT (Deauville score 1). CONCLUSIONS: This case illustrates the critical role of emergency surgical intervention as a bridge to definitive chemotherapy in life-threatening cardiac lymphoma. Our experience extends the applicability of endotracheal tube-assisted venous cannulation beyond its original description and suggests that this technique may serve as a valuable bailout option in emergency cardiac oncology surgery when conventional inferior vena cava cannulation is technically impossible.