대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1219 Date 2021-03-02

  • Courtesy of Won Jae Choi, Jeong Joo Woo / Nowon-Eulji Univirsity Hospital
  • Age/Sex 78 / M
  • Chief Complaintdyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Intracardiac lymphoma
Radiologic Findings
Fig 1-6. CT images show an irregular soft tissue lesion in the Rt atrium with suspicious extension to the inferior vena cava. Note diffuse wall thickening of Rt atrium and mild pericardial effusion. On the coronal CT image, there was no definite evidence of thrombus in the pulmonary artery.

PET/CT images show hypermetabolic uptake in the thickened wall of the Rt atrium. There is also significant FDG uptake in both lateral cervical lymph nodes.
Brief Review
Primary cardiac lymphoma is very rare. It accounts for about 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. Cardiac lymphomas are most commonly diffuse large cell lymphomas. Patients with cardiac lymphoma commonly show dyspnea, congestive heart failure, pericardial effusion, and hemopericardium. Cardiac arrhythmias and nonspecific electrocardiographic abnormalities are also common, notably AV blocks ranging from first degree to third degree. On CT, cardiac lymphoma manifests as infiltrative epicardial or myocardial mass (often attenuating relative to the myocardium). Cardiac lymphoma shows T1WI hypointensity and T2WI hyperintensity on MRI. The right atrium is most commonly involved. The prognosis of cardiac lymphoma is usually poor with the late diagnosis being a major factor affecting the outcome. Management of cardiac lymphoma is varied, with treatment combination including chemotherapy, radiation therapy, and surgery.
References
• JEUDY, Jean, et al. From the radiologic pathology archives: cardiac lymphoma: radiologic-pathologic correlation. Radiographics, 2012, 32.5: 1369-1380.
• VERSLUIS, P. J.; LAMERS, R. J. S.; VAN BELLE, A. F. Primary malignant lymphoma of the heart: CT and MRI features. In: RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. © Georg Thieme Verlag Stuttgart· New York, 1995. p. 533-534.
• MIGUEL, Carlos E.; BESTETTI, Reinaldo B. Primary cardiac lymphoma. International journal of cardiology, 2011, 149.3: 358-363.
Keywords

No. of Applicants : 86

▶ Correct Answer : 14/86,  16.3%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , France LE GUEN RAPHAEL
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Ajou University Hospital , Korea (South) SEUNGJIN HAN
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Correct Answer as Differential Diagnosis : 34/86,  39.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Korea (South) MINJI KIM
  • - HHS , Canada S LEE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Other , Korea (South) MINSU KIM
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - , Japan HIROAKI ARAKAWA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - , Japan TOMOKI IMOKAWA
  • - Private sector , Greece VASILIOS TZILAS
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
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