2021 Volume 3 Issue 5 Pages 306-307
A primary cardiac lymphoma is a rare cardiac tumor, and a correct histopathological diagnosis is important to improve a patient’s prognosis.1
A 76-year-old man who presented with dyspnea, atrial fibrillation, and a pericardial effusion was referred to Tokyo Women’s Medical University Hospital. Multislice computed tomography demonstrated invasion of a cardiac tumor adjacent to the right atrioventricular groove into the right atrium (Figure A). For an accurate histopathological diagnosis to determine the chemotherapy regimen, a transvenous biopsy was performed with the backup of a cardiovascular surgeon team. The entire shape of the intracardiac tumor was digitally reconstructed using an electroanatomical arrhythmia mapping system with intracardiac echographic capability (CARTOSOUND; Biosense Webster, Irvine, CA, USA; Figure B). A deflectable long sheath (C MAP SYMMETRY; Zeon Medical, Tokyo, Japan) inserted from the right groin was advanced to the cardiac tumor with the aid of real-time intracardiac imaging with the CARTOSOUND (Figure C; Supplementary Movie). Standard biopsy forceps (Cordis, Santa Clara, CA, USA) that were inserted into the sheath were advanced to the tumor and were used to obtain several samples without any complications, such as iatrogenic tumor embolism. The histopathological diagnosis was a diffuse large B cell lymphoma (Figure D), and the tumor had almost disappeared 6 months after chemotherapy.
(A) Multislice computed tomography of a lobate cardiac tumor (T) that had invaded the right atrium. (B) A 3-dimensional image of the cardiac tumor with 2 components (T1, T2) reconstructed using the CARTOSOUND (right anterior oblique view). IVC, inferior vena cava; L, left; R, right; SVC, superior vena cava. (C) A 2-dimensional intracardiac echography image used to help navigate a deflectable sheath (arrow) and biopsy forceps to the cardiac tumor. The arrow indicates the deftectable sheath toward the T1. (D) Histopathological findings of the tumor, which was diagnosed as a diffuse large B cell lymphoma.
The CARTOSOUND could clearly describe the intracardiac tumor and was useful for a safe and effective transvenous biopsy rather than the standard fluoroscopy-guided technique.
N.H. is a member of Circulation Reports’ Editorial Team.
This study was approved by the Tokyo Women’s Medical University (2020-0015).
Supplementary Movie. CARTOSOUND movie of Figure B and C.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circrep.CR-21-0038
