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Dysphagia is an uncommon presentation of systemic immunoglobulin light-chain (AL) amyloidosis with multiple myeloma (MM). Gastrointestinal (GI) involvement usually manifests with altered motility, malabsorption or bleeding. Furthermore, patients identified with GI amyloidosis, without previous diagnosis of a plasma cell disorder, are extremely rare. We report an elderly woman who presented with acute on chronic cardiac dysfunction, sick sinus syndrome and acute renal failure. While admitted, she developed intermittent dysphagia to both solids and liquids. Oesophagogastroduodenoscopy showed ulcerations of oesophagus and duodenum. Biopsies revealed focal amyloid deposition, stained with Congo red. Renal biopsy revealed amyloid deposition in renal arterioles. She underwent a bone marrow biopsy confirming MM, represented by more than 15% plasma cell population. She was started on treatment for heart failure, induction chemotherapy for MM and percutaneous gastrostomy tube for feeding. However, she continued to deteriorate, eventually opting for hospice, and ultimately died 2 days after discharge from hospital.

A 56-year-old Caucasian woman with severe chronic obstructive pulmonary disease (COPD) on home oxygen presented with a severe exacerbation. Vitals included a blood pressure of 111/73 mm Hg, a pulse of 102/minute, respiratory rate of 13/minute and O2 saturation of 84% on oxygen of 2–3 L/minute by nasal cannula. She was lethargic, confused and was wheezing. She was placed on bi-level positive airway pressure (BiPAP) but her mentation continued to deteriorate. White cell counts were normal. Chest X-ray showed hyperinflated lungs but no infiltrates. Arterial blood gases revealed severe hypercapnic respiratory acidosis with a pH of 7.26, pCO2 of 100.1 mm Hg, pO2 of 187 mm Hg and bicarbonate of 47 mmol/L. In spite of BiPAP, her acidosis worsened with a pCO2 of 131 mm Hg. …

Most benign primary cardiac tumours are myxomas; non-myxomatous tumours are less common but comprise a wide variety. Cardiac lipoma is a rare non-myxomatous variety. A 70-year-old Caucasian woman with right breast cancer status postpartial mastectomy underwent surveillance MRI of the breast and was found to have a possible right atrial (RA) mass. She also reported frequent headaches and palpitations. She underwent a transoesophageal echocardiogram which showed a 2.6×1.6×1.6 cm echogenic mass at the superior vena cava (SVC) and RA junction. She was anticoagulated for a possible thrombus without resolution. Surgical excision was undertaken in view of ongoing symptoms and partial occlusion of the SVC. Intraoperatively, a 2-3 cm smoothly textured lobulated mass was found and histopathology showed adipose tissue consistent with lipoma. The postoperative course was uneventful, and the patient was discharged in stable condition.