Abnormal Cardiac Silhouette in a Patient With Hodgkin's Disease

Abstract

History Hodgkin's disease, mixed cell type, was diagnosed in a 38-year-old woman after biopsy of an enlarged left supraclavicular lymph node in May 1975. Chest roentgenogram showed right and left paratracheal masses (Fig 1), and her lymphoma was subsequently staged as IIIA after splenic involvement was found at laparotomy. She received external beam irradiation with 4,500 rads to a standard thoracic mantle and 4,000 rads to inverted Y and right and left inguinal fields. The paratracheal adenopathy disappeared after irradiation, but the cardiac silhouette was noted to be abnormal in August 1977 (Fig 2). Diagnosis Recurrent Hodgkin's disease involving the paracardiac lymph nodes at the cardiac apex. Comment Figure 2 shows a mass in the left cardiophrenic angle that was not present on the earlier film. Histological proof of Hodgkin's disease was obtained by a fluoroscopically guided transcutaneous fine-needle aspiration biopsy. Mediastinal lymph node involvement is common in Hodgkin's disease,