The diagnosis of a giant cardiac malignant lymphoma in the right ventricle: a case report

Primary diffuse large B-cell lymphoma of the heart: A rare case of heart failure

A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.

The diagnosis of a giant cardiac malignant lymphoma in the right ventricle: a case report

Cardiac lymphoma is extremely rare in patients with normal immune function and difficult to identify through routine examinations in patients with atypical clinical manifestations, making early diagnosis very difficult. We reported a 71‐year‐old male patient who was repeatedly diagnosed of pulmonary infection, suspected lung tumour, and Kimura disease in other hospital due to cough, expectoration, and dyspnoea. Later on, the patient visited our hospital due to heart failure and epistaxis. Transthoracic echocardiogram confirmed the presence of a space‐occupying lesion in the right heart, cardiac magnetic resonance imaging preliminarily determined the nature of this lesion, finally, ¹⁸F‐fluorodeoxyglucose positron‐emission tomography/computed tomography, and nasal mass biopsy confirmed the diagnosis of cardiac malignant lymphoma, and the pathological type was diffuse large B‐cell lymphoma.