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(Circulation. 1998;97:220-221.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Primary Cardiac B-Cell Lymphoma

Hiroshi Tada, MD; Ken-ya Asazuma, MD; Eichi Ohya, MD; Takio Hayashi, MD; Tsuguhiko Nakai, MD; Takashi Nakayama, MD; ; Takanori Ueda, MD

From the Third (H.T., K.A., T.H., T. Nakai) and First (T. Nakayama, T.U.) Departments of Internal Medicine, Fukui Medical School, and the Department of Internal Medicine (E.O.), Izumigaoka Onsen Hospital, Fukui, Japan.

A 67-year-old woman was admitted to a hospital because of the recent onset of general malaise. She had a classic lilac-colored rash over her eyelids, the bridge of her nose, her cheeks, elbows, and knees and weakness in the proximal limb muscles. A diagnosis of dermatomyositis was confirmed by skeletal muscle biopsy. She was started on a course of oral glucocorticoids. Three months later, she complained of dyspnea. An echocardiogram revealed a massive pericardial effusion with evidence of both right atrial and ventricular collapse consistent with cardiac tamponade. Pericardiocentesis yielded 1000 mL of exudative bloody fluid with a lactate dehydrogenase value of 23 950 IU/L. Cytology revealed cells believed to represent lymphoma.

The patient was referred to Fukui Medical School for further investigation in August 1995. Transesophageal echocardiography showed a dense thick mass in the right atrioventricular groove extending into the right ventricular free wall (Fig 1A). The right ventricular wall and the left ventricular inferior wall were thickened and exhibited high echogenicities (Fig 1B). A small pericardial effusion was also noted. MRI demonstrated a thick mass in the right atrioventricular groove and the thickened right ventricular and left ventricular inferior walls, suggesting significant massive cardiac involvement (Fig 2A through 2C). The brightness of these lesions and pericardium was increased in T2-weighted images, and Gd-DTPA enhanced the lesions heterogeneously (Fig 2D). Contrast right atrial angiography demonstrated a zonal filling defect at the right atrioventricular groove, indicating cardiac involvement in that region (Fig 3). Full-body CT and . . . [Full Text of this Article]

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