Abstract
Primary cardiac lymphoma (PCL) is very rare, and is extremely challenging to diagnose due to nonspecific symptoms. When discovered, the right atrium and ventricle are most commonly affected, while diffuse cardiac involvement is uncommon. PCL is fatal unless promptly diagnosed and treated. Herein, we present the case of a 36-year-old immunocompetent male who presented with a 5-year history of non-specific chest symptoms and was diagnosed with primary diffuse cardiac large B-cell lymphoma involving the entire heart.
Highlights
Primary cardiac lymphoma (PCL) is a very rare disorder that presents with nonspecific symptoms, making diagnosis challenging [1]
The incidence of primary cardiac tumors is approximately 0.02%, and PCLs account for approximately 1% of primary cardiac tumors and the majority is diffuse large B-cell lymphoma [3]
Diagnosis of PCL is often delayed due to nonspecific symptoms, and the prognosis is poor with a reported median survival of 7 months after initiation of treatment [5, 6], though improved survival has been seen with the addition of rituximab to chemotherapy regimens [4]
Summary
Primary cardiac lymphoma (PCL) is a very rare disorder that presents with nonspecific symptoms, making diagnosis challenging [1]. We present the case of a 36year-old immunocompetent male with a 5-year history of worsening chest symptoms who was diagnosed with a primary diffuse cardiac large B-cell lymphoma. Physical exam revealed a heart murmur, ECG showed a Mobitz I AV block, RBBB, and right axis deviation, and chest radiograph demonstrated an enlarged heart. The final diagnosis was primary diffuse cardiac large B-cell lymphoma. After the 2nd cycle, the patient developed ventricular tachycardia and received synchronized cardioversion with resultant 1st degree AV block. He experienced paroxysmal ventricular tachycardia after the 4th cycle that responded to cardioversion. Follow-up echocardiogram demonstrated adequate global systolic and diastolic functions, with significant reduction of myocardial thickness and resolution of pericardial effusion (Figure 1C, D)
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