Left Atrial Compression by a Mediastinal Lymphoma Presenting with Paroxysmal Atrial Fibrillation

Extrinsic left atrial compression is an uncommon source of hemodynamic compromise and arrhythmias caused by many mediastinal structures. We describe a case of a 72-year old woman presenting with symptoms of confusion and atrial fibrillation. Transthoracic echocardiography demonstrated extrinsic left atrial compression caused by an enlarged lymph node. Compression of the left atrium caused impaired left atrial filling, leading to pulmonary vascular congestion and pulmonary edema. To our knowledge, the present case is the first reported case of mediastinal follicular lymphoma presenting with atrial fibrillation and heart failure by externally compressing the left atrium.