Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Rare disease
Simon Antoine Sarr, Abdou Majib Gaye, Fatou Aw, Jean de Dieu Nzambaza, Malick Bodian, Kana Babaka, Mouhamadou Bamba Ndiaye, Adama Kane, Maboury Diao, Serigne Abdou Ba
(Department of Cardiology, Teaching Hospital Aristide Le Dantec, Dakar, Senegal)
Am J Case Rep 2017; 18:281-285
Cardiac lymphoma is a rare entity, defined by the non-extra cardiac location at diagnosis.
CASE REPORT: Our patient was a 32-year-old female with no particular medical history, who presented with right heart failure with recurrent ascites and pleural effusion. There was a progressive worsening exertional dyspnea. On admission, examination revealed an irregular tachycardia at 170 beats per minute (bpm) and congestive heart failure. The electrocardiogram scored full tachyarrhythmia by atrial fibrillation with an average ventricular rate of 179 cycles per minute. Doppler echocardiography showed dilatation and systolic dysfunction of the left ventricle. There were dilated atria. We noted a large mass in the right atrium, which was less mobile, heterogeneous, integral with the wall, and filling three quarters of the cavity. It clogged the tricuspid valve in diastole. CT scan showed a tissue process enhanced after contrast injection, occupying the predominant cavities in the right atrium and filling it. Its borders were irregular. The lesion was extended to the posterior mediastinum, in front of the vertebral axis. In addition, there was a thrombosis of the jugular vein and the inferior vena cava. There was no other tumor site noted.
The patient died after presenting with cardiovascular shock associated with refractory right heart failure. Pathology examination confirmed T-cell lymphoma.
CONCLUSIONS: The primitive cardiac lymphoma is an entity of intra-cardiac masses. It is therefore to be considered even if the diagnosis is challenging.
Keywords: Echocardiography, Heart Failure, Heart Neoplasms, Lymphoma, T-Cell