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A 66-year-old man presented with dull, left-sided chest pain for 1 week occurring mainly at rest. The symptoms had been present for 1 month but had increased in frequency over the preceding 3 days. He became acutely short of breath with substernal chest pain while climbing a flight of stairs the day of admission. The pain was pressure-like, did not radiate and was associated with presyncope, but not syncope, diaphoresis, nausea nor vomiting. He had no past medical history of cardiac disease but did have risk factors for coronary artery disease (CAD) including hypertension, history of smoking and the metabolic syndrome. His past medical history was also significant for non-Hodgkin's stage IV marginal zone B cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) 4 years earlier. Vital signs and physical exam were normal without murmurs, …
Contributors All authors had a highly significant contribution to this work. RDL drafted the article and collected images. MP, JDV and DRM collected additional surgical and pathological images and contributed significantly to manuscript revisions. GK conceptualised the format, contributed significantly to revisions and obtained clinical images.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
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