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Archives of cardiovascular diseases
Volume 105, n° 8-9
pages 463-464 (août 2012)
Doi : 10.1016/j.acvd.2010.07.008
Received : 18 July 2010 ;  accepted : 27 July 2010
Primary lymphoma of the heart
Lymphome primaire du cœur
 

James Pemberton a, , Nigel Cooper b, Antoinette Kenny a
a Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK 
b Department of Histopathology, Freeman Hospital, Newcastle upon Tyne, UK 

Corresponding author. Green Lane Cardiovascular Services, Auckland City Hospital, Park Road, Grafton, Auckland 1023, New Zealand.

Keywords : Cardiac lymphoma, Cardiac tumour, Echocardiography

Mots clés : Lymphome cardiaque, Tumeur cardiaque, Échocardiographie


A 79-year-old man was admitted with increasing shortness of breath and general deterioration. The results of routine haematology and biochemistry tests on admission were unremarkable. A non-electrocardiogram-gated computerized tomography (CT) scan of his chest was arranged to investigate his symptoms. The CT showed a small pericardial effusion and raised the suspicion of a mass in the myocardium. A transthoracic echo showed a small global pericardial effusion with no echocardiographic evidence of tamponade. The echo scan also revealed a very thickened pericardium and a large mass arising in the interventricular septum with frond-like projections into the left ventricular cavity (Figure 1, Appendix A). A decision not to operate to try to obtain a sample for tissue diagnosis was made with the patient. The patient’s condition deteriorated rapidly and he died several days later. A hospital postmortem was performed and this confirmed the presence of a large mass in the septum, as seen on the transthoracic echo (Figure 2). This was in continuity with a pale and haemorrhagic fleshy tumour that encased the heart. Small tumour deposits were present in both lungs but not in any lymph nodes. The results of histological analysis confirmed the presence of a high-grade B-cell lymphoma.



Figure 1


Figure 1. 

Apical four-chamber view of the left ventricular cavity with the large mass in the interventricular septum. The large frond-like projections from this mass can be seen in the left ventricular cavity.

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Figure 2


Figure 2. 

Post-mortem view of the heart, equivalent of a short-axis view, showing the left ventricular (LV) and right ventricular (RV) cavities with the large mass in the interventricular septum and the surrounding pericardial tumour.

Zoom

Primary cardiac tumours are rare malignancies, accounting for approximately 1% of tumours. They are usually pericardial and myocardial arising largely in the left atrium or ventricle. This patient’s tumour was originally seen in the septum with the large frond-like projections into the left ventricle. Unlike many patients with myocardial tumours, this patient did not suffer conduction defects. His condition deteriorated rapidly due to constriction from the extensive pericardial involvement. Lymphoma should be considered in patients with myocardial or pericardial involvement. Palliative chemotherapy and radiotherapy have been used to treat these tumours, which otherwise have a very poor prognosis.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.


Appendix A. Supplementary data

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 Movie 1 
Movie 1. 

Apical four-chamber view of the heart with the large mass seen in the interventricular septum and the large projections in the left ventricular cavity. The thickened pericardium can also be appreciated.

Click here to download the file (290 Ko)
 Movie 2 
Movie 2. 

Parasternal long-axis view of the heart showing the large mass and also the small pericardial effusion.



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