Large Primary Cardiac Lymphoma Causing Functional Tricuspid Valve Stenosis

Abstract

Causing Functional Tricuspid Valve Stenosis A previously healthy 49-year-old man presented with an 8-week history of progressive dyspnea on exertion, nonproductive cough, and chills. Physical examination results and laboratory findings suggested right-sided heart failure. A transthoracic echocardiogram (TTE) revealed a large multilobular mass extending from the right atrium through the tricuspid valve (TV) into the right ventricle (Fig. 1). Color-f low Doppler findings at the level of the TV were consistent with functional stenosis (Fig. 2A). The mean gradient across the TV was 9 mmHg at a heart rate of 85 beats/min (Fig. 2B). The uptake of echocardiographic contrast medium enabled us to see the mass further penetrate the myocardial free wall into the pericardium, suggesting neovascularity. Histologic analysis of a biopsy specimen revealed large atypical cells consistent with lymphoma (Fig. 3). A TTE obtained 12 days after chemotherapy began revealed tumor shrinkage (Fig. 4A). The mean gradient had decreased to 3 mmHg, and the patient's symptoms had improved. Four months after chemotherapy had begun, scans obtained with use of positron-emission tomography/computed to