A cystic lesion encases the right coronary artery

Abstract

Case report description: A 75-year-old man presented to our department with incidental finding of pericardial effusion. He suffered from general malaise and body weight loss in recent 3 months. He had chronic hepatitis B and an abdominal computed tomography (CT) disclosed a new soft tissue nodule 1.7x1.3 cm in size over the S7 of liver and pericardial effusion. A transthoracic echocardiography showed a cyst-like lesion about 2.6x2.9 cm over right atrioventricular (AV) groove and moderate pericardial effusion. (Panel A and B) The patient received subsegmentectomy of liver and the pathology was compatible with hepatocellular carcinoma. A follow-up echocardiography showed progression of the lesion one month later. A cardiac CT disclosed a soft tissue mass spreading along the right AV groove and encasing the right coronary artery (RCA). (Panel D) A positron emission tomography (PET) scan disclosed increase of radiolabeled 18F-2-fluoro-deoxy-D-glucose uptake along the right AV groove. (Panel C) Hence, video-assisted thoracoscopic biopsy was done and the pathology findings were compatible with diffuse large B cell lymphoma. (Panel D and E) The patient was diagnosed as primary cardiac lymphoma (PCL) and received chemotherapy. A follow-up echocardiography showed markedly decrease of the tumor size 3 months after chemotherapy. (Panel G and H) Conclusion: Our case presented as hepatic nodule and cystic lesion encasing RCA with pericardial effusion, and finally diagnosed as double cancers, namely hepatocellular carcinoma and PCL. This case reminds us that an aggressive work-up can help a patient with unexplained intra-cardiac mass and pericardial effusion. ![Figure][1] Figure 1 [1]: pending:yes