대한흉부영상의학회 Weekly Chest Cases

Case No : 1361 Date 2023-11-21

Courtesy of Min Kyung Jung, Sang Young Lee, Jeong Min Ko / Department of Radiology, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea
Age/Sex 74 / M
Chief ComplaintDyspnea, facial edema

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Diagnosis With Brief Discussion

Diagnosis: Primary cardiac lymphoma
Radiologic Findings: Fig 1. Chest radiograph shows the enlargement of the heart and no signs of pulmonary edema.

Fig 2-5. After pericardiocentesis, axial and coronal contrast-enhanced mediastinal window setting of chest CT scan shows a large mass that arises from the right atrium and extends into the SVC and right ventricle. The mass extends along the epicardial surfaces of the right atrium, encasing coronary artery. Pulmonary thromboembolism is also noted in both lower lobes.

He underwent surgical biopsy and pathologic result was diffuse large B-cell lymphoma. He made an additional systemic evaluation, and there was no evidence of lymphoma, except for the heart.
Brief Review: Lymphoma of the heart and pericardium is usually present as one aspect of disseminated disease and rarely occurs as a primary malignancy. It accounts for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. Cardiac lymphomas are most commonly diffuse large cell lymphomas and frequently manifest as an ill-defined, infiltrative mass. Atrial location is typical; the right atrium is most often affected. Pericardial thickening or effusion is often a common early feature of disease. Infiltration of atrial or ventricular walls with extension along epicardial surfaces is also a notable feature. At computed tomography, the attenuation of cardiac lymphoma may be similar to or lower than that of normal myocardium. At magnetic resonance imaging, it has variable signal intensity and contrast enhancement. Clinical manifestations may include pericardial effusion, cardiac arrhythmias, and a variety of nonspecific electrocardiographic abnormalities, notably first- to third-degree atrioventricular block. Treatment most commonly includes anthracycline-based chemotherapy and anti-CD20 treatment. Chemotherapy has been used alone or combined with radiation therapy. Palliative surgery has been performed, mainly for tumor debulking. The prognosis for patients with either primary or secondary lymphomatous heart involvement is usually poor; late diagnosis is one of the major factors affecting outcome.
References: RadioGraphics 2012; 32:1369–1380
Keywords

No. of Applicants : 76

▶ Correct Answer : 27/76, 35.5%

- The University of Tokyo Hospital , Japan JUN KANZAWA
- , Japan KYOKO NAGAI
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- Chonnam National University Hospital , Korea (South) HYUNJIN KIM
- Other , Korea (South) SEONGSU KANG
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Yokkaichi municipal hospital , Japan HIKARI FUKUI
- OITA UNIVERSITY , Japan FUMIKA ISHITOBI
- Gifu University Hospital , Japan Yo Kaneko
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- , Japan SHUNJIRO NOGUCHI
- , Korea (South) HEONSEOK LEE
- Mie university , Japan MIYUKO FUJITA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Korea University Guro Hospital , Korea (South) LEE DAKYONG
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Mie university , Japan SHIKO OKABE
- Mie University Hospital , Japan KENSUKE DOMAE
- Fukuoka university , Japan KEISUKE SATO
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
- Matsunami General Hospital , Japan TARO TAKEDA
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- , Korea (South) JIN WOO YOON
- Hanyang University Hospital , Korea (South) SEUNG JIN YOO

▶ Correct Answer as Differential Diagnosis : 28/76, 36.8%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Oita university , Japan AYUMI KAMEI
- Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Osaka University , Japan AKINORI HATA
- Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Nankai medical center , Japan NORITAKA KAMEI
- Kyoto University Hospital , Japan YASUHISA KURATA
- Other , Korea (South) CHAEHUN LIM
- Tokyo Medical and Dental University , Japan MIKIYA FUJII
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- GHICL , France MANUEL TOLEDANO
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Others , India PURUSHOTHAMA RAO TUMMALA
- Chonnam National University Hospital , Korea (South) KIM SANG GYUN
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Kyoto University , Japan SHO KOYASU
- Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Samsung Medical Center , Korea (South) SEONGUK KIM
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- Kyoto university , Japan AKIHIKO SAKATA
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Jiangsu province hospital , China WANGJIAN ZHA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1361 Date 2023-11-21

Discussion

No. of Applicants : 76