Abstract
IntroductionIn malignant lymphoma, cardiac involvement, which usually forms pathologically focal and firm nodules in the cardiac walls, is considered to be a late manifestation of the disease.Case presentationWe describe the case of a 71-year-old Asian Japanese woman whose first presentation of lymphoma was congestive heart failure. Multiple imaging examinations and laboratory findings led to a presumed diagnosis of a malignant lymphoma. A tissue diagnosis of the mediastinal mass could not be performed due to our patient’s generally poor condition. Our patient received corticosteroid therapy, but died 42 days after her admission. An autopsy revealed lymphoid cells encircling her ventricular wall and infiltrating her endocardium. A histological examination confirmed the diagnosis of diffuse large B-cell lymphoma.ConclusionImaging examinations such as echocardiography, computed tomography with three-dimensional reconstruction, and gallium-67-citrate scintigraphy could clearly detect the diffuse cardiac involvement antemortem. A combination of these imaging techniques could provide a working diagnosis and allow empirical initiation of treatment in patients with poor general condition.
Highlights
In malignant lymphoma, cardiac involvement, which usually forms pathologically focal and firm nodules in the cardiac walls, is considered to be a late manifestation of the disease.Case presentation: We describe the case of a 71-year-old Asian Japanese woman whose first presentation of lymphoma was congestive heart failure
We present the case of a patient with a malignant lymphoma with diffuse cardiac involvement whose first presentation was congestive heart failure
The patient presented here had a rare case of malignant lymphoma with diffuse cardiac involvement that initially presented as cardiac failure
Summary
The patient presented here had a rare case of malignant lymphoma with diffuse cardiac involvement that initially presented as cardiac failure. Diffuse cardiac involvement of malignant lymphoma may result in cardiac dysfunction and a poor prognosis. Echocardiography can detect cardiac involvement, including the inner structure of the cardiac wall and the impairment of cardiac function caused by these structures; CT with threedimensional reconstruction can survey the lymphomatous involvement, including the epicardial surface; and nuclear scanning can provide information suggesting whether or not the mass is malignant. A combination of these imaging techniques can strongly suggest lymphomatous involvement of the heart, providing a working diagnosis and allowing empirical initiation of treatment. Consent Written informed consent was obtained from the patient’s next-of-kin for publication of this manuscript and any accompanying images. Competing interests The authors declare that they have no competing interests
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