FDG PET/CT leads to the detection of metastatic involvement of the heart in non-Hodgkin’s lymphoma

Abstract

We describe two rare cardiac findings on baseline FDG PET in histologically proven aggressive large B-cell non-Hodgkin's lymphoma (NHL).The first case is a 21-year-old woman with stage IV NHL with a superior mediastinal mass and two lung nodules on contrast-enhanced CT images. FDG PET/CT showed intense uptake in these lesions and, without contiguity, a round pathological cardiac uptake in the apical septum and the right ventricle (a, b FDG PET images; c, d fusion FDG PET/CT images; transverse and sagittal, respectively). The electrocardiogram showed negative T-waves in the septal location with left chest pain and dyspnoea. Transthoracic echocardiography confirmed the presence of a 3-cm mass near the apex with development towards the right and left ventricles, without thrombus or pericardial effusion. Cardiac MR imaging revealed a hyperintense aspect on T2-weighted sequences, isointense on T1 sequences (e cine sequence T2-/T1-weighted image; f short-axis T2-weigted black blood SPIR image). This mass had disappeared on FDG PET/CT and echocardiography performed after two and four cycles of chemotherapy.The second case is a 51-year-old man with stage III NHL on CT imaging who underwent FDG PET/CT revealing posterior parietal right auricular involvement (g transverse FDG PET image; h fusion FDG PET/CT image), confirmed on MR imaging (i T1-weighted SE image, black blood, four chambers view). The FDG PET/CT scan at the end of treatment was normal.Metastases to the heart and pericardium are rare [1] in NHL but are associated with a poor prognosis, and are usually revealed by cardiac complications [2]. In these cases, FDG PET allowed early diagnosis and earlier chemotherapy, leading to the disappearance of cardiac locations before the occurrence of any cardiac complications, and therefore improving survival.Conflicts of interest None. References1. Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement of the heart and pericardium: CT and MR imaging.

Extensive Extranodal Involvement of Rare Sites in Non Hodgkin’s Lymphoma Detected on 18F- FDG PET-CT: A Case Report

“…The involvement is usually revealed by cardiac complications and is associated with a poor prognosis [21,22]. Few cases of cardiac involvement in NHL have been reported, both primary and metastatic, detected by 18 F-FDG PET-CT [9][10][11]. Julian et al reported two cases of NHL with cardiac involvement (apical septum, right ventricle and right auricle) detected by 18 F-FDG PET-CT that allowed an early diagnosis and chemotherapy, therefore, improving the survival [9].…”

“…Few cases of cardiac involvement in NHL have been reported, both primary and metastatic, detected by 18 F-FDG PET-CT [9][10][11]. Julian et al reported two cases of NHL with cardiac involvement (apical septum, right ventricle and right auricle) detected by 18 F-FDG PET-CT that allowed an early diagnosis and chemotherapy, therefore, improving the survival [9]. Synchronous lesions were detected in bilateral atria in our case, which were isodense and non-enhancing on CECT and therefore missed on CT.…”

“…The role of 18 F-FDG PET-CT in detection, staging and restaging of patients with extranodal involvement in NHL has also been reported in the literature [2,3]. Multiple isolated cases with extranodal involvement of NHL, detected on PET-CT, have been previously reported [8][9][10][11]. Here, we report a rare case of extranodal NHL involving multiple organs namely heart, bilateral kidneys, bowel, and left testis, in addition to mesenteric and retroperitoneal lymph nodes which were detected on 18 F-FDG PET-CT.…”

18F-FDG PET/CT in Staging and Response Evaluation of Rare Case of Non-Hodgkin's Lymphoma Involving Pericardium, Kidney and Pancreas

“…The involvement is usually revealed by cardiac complications and is associated with a poor prognosis. Julian et al reported two cases of DLBCL with cardiac involvement (apical septum, right ventricle and right auricle) detected by 18F-FDG that allowed an early diagnosis and chemotherapy, therefore, improving the survival [4]. Few cases of cardiac involvement in DLBCL have been reported, both primary and metastatic, detected by 18F-FDG [5,6].…”

FDG PET/CT in Detection of Metastatic Involvement of Heart and Treatment Monitoring in Non-Hodgkin′s Lymphoma

“…[7] In literature a few case reports have shown the pattern of involvement of metastatic involvement of the heart in non-Hodgkin's lymphoma. [89] We describe a unique case where FDG P et al lowed early diagnosis, prompt treatment and monitor response to chemotherapy of cardiac lesion, thus leading to the resolution of heart lesion before the occurrence of any cardiac complications.…”