T cell lymphoma involves cardiac structures rarely and tends to be more
aggressive. Pericardial effusion is the most common manifestation of
cardiac involvement with restrictive cardiomyopathy due to tumor
infiltration being extremely rare. The presence of paroxysmal nocturnal
dyspnea and orthopnea in a patient presenting with pericardial effusion
or tamponade should alert the physician towards possible myocardial
disease warranting re-evaluation after pericardiocentesis. We describe a
14-year-old boy with advanced T cell lymphoma presenting with cardiac
tamponade. Repeat echocardiography after pericardiocentesis revealed
mediastinal mass infiltrating cardiac chambers and great vessels along
with features of restrictive cardiomyopathy secondary to tumor
infiltration.