Multimodality advanced cardiac imaging for diagnosis and treatment monitoring in cardiac lymphoma

A 76-year-old man presented with progressive breathlessness, orthopnoea, and peripheral oedema over 2 weeks, without weight loss, fever, or night sweats. Bedside echocardiography revealed a large pericardial effusion with signs of tamponade and a right ventricular mass (Panel A). Ultrasound and fluoroscopy guided pericardiocentesis removed 1800 mL of blood-stained fluid. Cardiovascular magnetic resonance (CMR) imaging confirmed a large (9.1 × 6.5 cm) mass (Panel B, Supplementary material onlineSupplementary material online,Video S1) infiltrating the pericardium, and encroaching into the right atrium and ventricle but sparing the right coronary artery (arrow). T1-weighted fat imaging showed no evidence of fatty infiltration and first-pass perfusion and late gadolinium imaging demonstrated vascularity, suggesting a malignant mass; most likely lymphoma or angiosarcoma. Fluorodeoxyglucose positron emission tomography showed extensive tracer uptake in the heart but no metastases (Panel C). Pericardial effusion cytology and histology confirmed high-grade B-cell lymphoma and a standard regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone (R-CHOP) were initiated with curative intent. Repeat CMR after three cycles of R-CHOP showed almost complete resolution of the mass (Panel D, Supplementary material onlineSupplementary material online,Video S2).
Source: European Heart Journal - Category: Cardiology Source Type: research