The echocardiographic exam for the diagnosis of cardiac involvement in non-Hodgkin lymphoma in childhood

Abstract

Clinical signs and symptoms of cardiac(Cd) involvement in non-Hodgkin lymphoma(NHL), is frequently undetected and diagnosis could be missed unless a routine echocardiographical investigation(echo) might be performed. To reveal the value and utility of echo for diagnose and follow up the Cd involvement in Nnhl n child, other than that determined by the specific treatment. Authors were studied 38 children: 21 males and 17 females, aged between 3month and 17 years with NHL), hospitalised. In all cases were performed: clinical exam, ECG, chest X-ray and echo. Cd involvement was proved in 6 cases (15, 8%); 5 cases (83%) T-cell and 1 case (17%) B-cell lymphoma; clinical signs on onset like astenia, dyspnea, cough, superior vena cava sdr have been assigned to the base disease. ECG: low voltage of QRS complexes and T waves. Chest X-ray: mediastinal involvement (5 pts) and massive right-side pleural effusion (1 case). Eco aspects: pericardial effusion (4) to cardiac tamponade (2); pericardial tumor (1 case). In 2 cases at first eco exam intra Cd masses: case 1 with a tumoral mass filling the right atrium(RA) with implantation base towards superior vena cava- confirmed later in the autopsy; case 2-tumoral mass extending from the free wall of the RA to the septal tricuspid valve leaflet, associated with an massive pericardial effusion. In the case 2 and in all cases with pericardial effusion on onset:at 1 year the echo turned to normality after chemotherapy. Because of high incidence of Cd involvement in NHL in child and antemortem diagnosis is often difficult, echo is necessary in all cases at the first exam, even if Cd involvement signs are missing, in order to prevent the evolution to Cd tamponade or other Cd emergency. Echo is the most important investigation to diagnose and follow-up the Cd involvement in NHL in child.