2020 Volume 2 Issue 3 Pages 209-210
A 72-year-old Japanese man was admitted with edema. Laboratory data were as follows: white blood cells, 8,600/mm3 without abnormal cells; lactate dehydrogenase, 1,297 IU/L; high-sensitivity troponin T, 0.14 ng/mL; C-reactive protein, 7.22 mg/dL; soluble interleukin-2 receptor, 604 IU/L; and N-terminal pro-brain natriuretic peptide, 2,825 pg/mL. Electrocardiography showed negative T wave in V1–6 leads. Echocardiography indicated a right ventricular (RV) mass (Figure A). Contrast-enhanced chest computed tomography (CT) showed a diffuse mass in the RV wall (Figure B) without any mass in the other organs. The mass surrounded the right coronary artery, but it was patent (Figure C). Cardiac magnetic resonance imaging (MRI) also demonstrated a diffuse mass in the RV wall (Figure D), with high intensity of T2 with saturated fat signal (Figure E), and heterogeneous gadolinium enhancement (Figure F). Surgical myocardial biopsy indicated a diffuse large B-cell lymphoma (Figure G,H). The patient was diagnosed with primary cardiac lymphoma (PLC).
(A) Echocardiography showed a right ventricular (RV) mass. (B,C) Contrast-enhanced computed tomography showed (B) a diffuse mass in the RV wall (arrows) with (C) normal coronary arteries. (D–F) Cardiac magnetic resonance imaging showed (D) a diffuse mass in the RV wall (arrows), (E) with high intensity of T2 with saturated fat signal (arrows), and (F) inhomogeneous gadolinium enhancement (arrows). (G,H) Myocardial biopsy showed cell infiltration with B lymphocytes (G, hematoxylin and eosin; H, CD-20 immunostaining). LA, left atrium; LV, left ventricle; RA, right atrium.
Although the mass had decreased 6 months after treatment with rituximab, pirarubicin, cyclophosphamide, vincristine, and prednisolone (R-THP-COP), the patient died of recurrence and metastasis 3 months later.
A multimodality imaging approach is mandatory although final diagnosis is confirmed by biopsy. PLC encases the coronary artery, but intraluminal involvement is rare. Thus, coronary CT angiography may be helpful for diagnosis, as well as MRI.
The authors declare no conflicts of interest. K.M. is a member of Circulation Reports ’ Editorial Team.
