A 68‐year‐old woman was admitted to a tertiary referral center after presenting to her local emergency department (ED) with a complaint of shortness of breath. She initially presented to the ED with a 6‐week history of dyspnea and cough. The results of her physical exam and chest x‐ray were consistent with heart failure, with an echocardiogram demonstrating diastolic dysfunction but preserved left ventricular function. The acute exacerbation of her cardiomyopathy was believed to be a result of an upper respiratory tract infection, and she was treated with antibiotics and an injection of methylprednisolone. Immediately after the steroid injection she became hypotensive and developed atrial fibrillation. On transfer, a chest CT on a pulmonary embolism protocol showed a right ventricular mass, which was confirmed by a repeat echocardiogram. Positron emission tomography (PET) imaging demonstrated increased uptake in the mass. The patient developed complete heart and underwent right heart catheterization for pacemaker placement and biopsy of the mass. Pathology demonstrated diffuse large B‐cell non‐Hodgkin's lymphoma. Staging with a CT scan and bilateral bone marrow biopsy demonstrated no other sites of disease. Because of her hypotensive episode with steroid infusion, she received her first course of CHOP (cyclo‐phosphamide, vincristine, adriamycin, prednisone) chemotherapy in the ICU, which occurred without complications.
Primary cardiac lymphoma is exceedingly rare, comprising fewer than 1% of all lymphomas and approximately 1.5% of cardiac tumors. More than 80% are B‐cell lymphomas, which often occur in immunocompromised hosts. The usual method of diagnosis is echocardiogram, and a PET scan can aid in the diagnosis. Patients can present with heart failure as well as arrhythmias and, as in the present case, hearts because of invasion into the conduction system. Chemotherapy is the treatment of choice. In addition to having the typical side effects of therapy, patients are at risk of cardiac perforation because most intracardiac lymphomas are invasive, and treatment results in rapid tumor regression. Because of the intravascular nature of this lymphoma, tumor lysis is also a concern with the initiation of treatment. Median survival from diagnosis is roughly 7 months, although some patients may be cured with chemotherapeutic treatment with or without stem cell transplant.
Heart failure is a common indication for hospital admission, with nearly 1.1 million admissions in 2003 according to the American Heart Association. Diastolic dysfunction is increasingly recognized as a cause of symptoms of cardiomyopathy. As demonstrated by the present case, diastolic dysfunction can occur as a result of a numerous processes including hypertension, cardiac ischemia, and infiltrative diseases. The present case illustrates how imaging can help to identify individuals whose heart failure may be a result of factors other than primary cardiac disease.
T. Figanbaum, None.
To cite this abstract:Figanbaum T. Intracardiac B‐Cell Lymphoma Presenting as New‐Onset Atrial Fibrillation and Diastolic Heart Failure. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 117. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/intracardiac-bcell-lymphoma-presenting-as-newonset-atrial-fibrillation-and-diastolic-heart-failure/. Accessed July 20, 2019.