Lymphoma presenting as an ejection systolic murmur

Abstract

We report the case of a 22-year-old gentleman with non-Hodgkin's lymphoma who presented with a 3-week history of non-specific symptoms and an ejection systolic murmur. Urgent transthoracic echocardiography demonstrated a large anterior mediastinal mass compressing the right ventricular outflow tract that was confirmed on subsequent computerised tomography.

Extrinsic pulmonary stenosis in primary mediastinal B‐cellular lymphoma

“…Only a few cases of right ventricular outflow tract obstruction secondary to diffuse large B‐cell lymphomas have been reported. Mediastinal masses, including nonmicrocytic lung carcinoma, non‐Hodgkin lymphoma, thymoma, teratoma, and malignancies of the pericardium or of unknown origin, rarely cause extrinsic compression of the heart, resulting in hemodynamically significant obstruction . The most common clinical manifestations associated with malignant extrinsic pulmonary compression include chest pain and dyspnea .…”

“…On electrocardiography, normal sinus rhythm as well as a right‐axis deviation or right‐ventricular hypertrophy may be present. Finally, the most common appearance on the chest radiogram is enlargement of the mediastinum, followed by a normal chest radiograph and cardiomegaly …”

“…TTE and transesophageal echocardiography are often ordered to evaluate the cardiac symptoms and can help to distinguish cardiac from noncardiac causes of valvular dysfunction . TTE and transesophageal echocardiography with Doppler examination have been found to be useful in the prompt identification of mediastinal masses and their effects on the otherwise healthy heart …”

Pseudo‐Pulmonic Stenosis in Non‐Hodgkin's Large B‐cell Lymphoma

“…There have only been a few cases reported of right ventricular outflow tract obstruction secondary to diffuse large B‐cell lymphomas. Mediastinal masses rarely cause extrinsic compression of the heart resulting in hemodynamically significant obstruction 2 . Echocardiography is often ordered to evaluate the cardiac symptoms and can help illicit cardiac from noncardiac causes of valvular dysfunction 2–4 .…”

“…Mediastinal masses rarely cause extrinsic compression of the heart resulting in hemodynamically significant obstruction 2 . Echocardiography is often ordered to evaluate the cardiac symptoms and can help illicit cardiac from noncardiac causes of valvular dysfunction 2–4 . Echocardiography has been found to be a useful modality in the prompt identification of mediastinal masses and their effects on the otherwise healthy heart 3,4 …”