Pericardial effusion as first presentation of disseminated non-Hodgkin’s lymphoma

Abstract

A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.

An Unusual Hodgkin's Lymphoma Journey: Cardiac Tamponade, Primary Refractoriness, Immune Thrombocytopenia, and Post-Traumatic Stress Disorder

“…PEEFs occur in less than 5% of primary lymphomas [ 1 ]. However, PEEFs and cardiac metastasis are diagnosed in up to 20% of disseminated lymphomas [ 2 ]. Cardiac involvement in malignancy can occur via the hematogenous, lymphatic, venous, and contiguous spread.…”

“…There is a role of imaging in the diagnosis of cardiac involvement by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI) which can identify pericardial lesions and borders with a better definition [ 6 ]. The pathologic diagnosis can be achieved by pericardial fluid analysis and/or pericardial/epicardial biopsy [ 2 ]. In our case, the initial pericardial fluid analysis did not show signs of lymphoma or infection.…”

“…Pericardial effusions (PEEF) occur in less than 5% of primary lymphomas [ 1 ]. However, PEEFs are diagnosed in up to 20% of disseminated lymphomas [ 2 ]. Cardiac tamponade (CTp) is exceedingly rare and only a few cases have been described with both HL and non-HL.…”