PMC5214451_01
Technically difficult, parasternal short axis view at the aortic valve level showing a large heterogeneous mass occupying a majority of the RVOT.
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The mass appeared adherent to the right atrium and ventricle and created both near-complete right ventricular cavity obliteration and significant obstruction of the right ventricular outflow tract with a peak gradient of 27 mmHg (normal RVOT gradient < 4 mmHg) (Figures 1 and 2).
Pre- and posttransthoracic echocardiogram images. (a) Apical four-chamber view demonstrating a large mass in the right ventricle with extension into the right atrium. (b) Apical four-chamber view demonstrating complete resolution of the mass after chemotherapy.
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The mass appeared adherent to the right atrium and ventricle and created both near-complete right ventricular cavity obliteration and significant obstruction of the right ventricular outflow tract with a peak gradient of 27 mmHg (normal RVOT gradient < 4 mmHg) (Figures 1 and 2). Remarkably, transthoracic echocardiography and PET/CT performed 9 weeks after her initial diagnosis of primary cardiac lymphoma revealed complete resolution of the right ventricular mass, pleural effusions, as well as adrenal nodule, and mediastinal and para-aortic lymph nodes (Figure 2).
Cardiac MRI image showing a large lobulated heterogenous mass in the right ventricle which limited the opening of the tricuspid valve.
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Its imaging characteristics were most concerning for invasive malignancy (Figures 3 and 4).
Cardiac MRI image showing a parasternal short axis view at the level of the papillary muscles demonstrates a large mass in the RV.
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Its imaging characteristics were most concerning for invasive malignancy (Figures 3 and 4).
Cardiac catheterization image of the right coronary artery demonstrating a significant filling defect in the distal artery.
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The left heart catheterization demonstrated severe stenosis of the distal right coronary artery due to encasement from the cardiac mass, which correlated to the territory of distal infarction (Figure 5).
Pathology specimen of cardiac tissue demonstrating lymphocytes infiltrating the cardiac muscle, consistent with cardiac lymphoma.
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CD5(-) and CD10(-) large B-lymphocytes compatible with diffuse large B-cell lymphoma (Figures 6 and 7). Cytology from pleural fluid corroborated this finding.
Immunohistochemical stain of cardiac muscle showing that the cells are positive for CD791, a B-cell marker.
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CD5(-) and CD10(-) large B-lymphocytes compatible with diffuse large B-cell lymphoma (Figures 6 and 7). Cytology from pleural fluid corroborated this finding.