Cardiac lymphoma with first manifestation of recurrent syncope-a case report and literature review

Abstract

Cardiac involvement, as an initial presentation of malignant lymphoma is rare. We report a 42-year-old Taiwanese man with frequent syncope. Routine electrocardiography disclosed complete atrioventricular block. Before permanent pacemaker implantation was undertaken, transthoracic echocardiography revealed a solid mass infiltrating the left atrium and interatrial septum. Transesophageal echocardiography proved cardiac neoplasm with biatrial infiltration. Endomyocardial tissue biopsy was performed under angiography guide. Pathology diagnosis unraveled large B-cell lymphoma. Despite aggressive chemotherapy, the patient's condition worsened and he died 2 months later.

Imaging Features of Primary Cardiac Lymphoma

“…Primary cardiac lymphoma (PCL) is an extremely rare entity that accounts for only 0.5% of extranodal lymphomas and 1.0% of cardiac tumors. [ 1 ] Because the tumor is clinically aggressive and fatal, it is of great significant to diagnose this disease and treat it promptly. Nevertheless, The diagnosis of PCL is very difficult due to its nonspecific clinical manifestations.…”

“…Nevertheless, The diagnosis of PCL is very difficult due to its nonspecific clinical manifestations. [ 1 ] Herein, we report the imaging findings in two cases of PCL.…”

“…Pathologically, the most common type of PCL is of B-cell origin (especially DLBCL). [ 1 2 ] The strict definition of PCL is that the tumor involves only the pericardial space and myocardium, without any other evidence of lymphoma on autopsy. [ 3 ] It is reported that PCL presents more common in the elderly age, with a male-to-female ratio of 2(3):1.…”

“…TTE is useful for detecting the tumor with a mode of real-time imaging. [ 1 ] CT and magnetic resonance imaging could not only reveal the infiltrating extent but also provide the intratumoral characteristics. [ 1 ] More specifically, CT can be used to clearly show the extracardiac spread rather than the intracardiac spread.…”

“…[ 1 ] CT and magnetic resonance imaging could not only reveal the infiltrating extent but also provide the intratumoral characteristics. [ 1 ] More specifically, CT can be used to clearly show the extracardiac spread rather than the intracardiac spread. By contrast, CMR provides a better alternative to demonstrate the infiltration of the myocardium and pericardium, which is the preferred tomographic method for observing PCL currently.…”