Multimodality imaging integrating TTE, CCT, CMR, and PET/CT successfully diagnosed primary cardiac lymphoma in a 54-year-old female, identifying a safe extracardiac biopsy target.
Case Report (n=1)
Multimodality imaging is essential in the diagnostic workup of suspected primary cardiac lymphoma to characterize the mass, exclude common etiologies, and identify safe extracardiac biopsy targets.
Primary Cardiac Lymphoma (PCL) is a rare malignancy that frequently masquerades as other cardiac conditions or may be missed due to nonspecific clinical presentations. This diagnostic challenge necessitates a comprehensive imaging approach to ensure accurate differentiation and management. A 54-year-old female presented with palpitations, chest discomfort, slight troponin elevation and lateral ST-segment depressions mimicking acute coronary syndrome. Initial transthoracic echocardiography (TTE) revealed a peri-atrial mass. Cardiac Computed Tomography (CCT) ruled out coronary artery disease. Instead, CCT showed a hypodense process exhibiting the “encasement sign” around the left circumflex artery. Cardiac Magnetic Resonance (CMR) further characterized the mass with T2/T1 hyperintensity and delayed enhancement, narrowing the differential to lymphoma versus IgG4-related disease. 18 F-FDG PET/CT demonstrated intense hypermetabolism and crucially identified a hypermetabolic paratracheal lymph node. Biopsy of the paratracheal node, chosen for its accessibility over cardiac tissue, confirmed diffuse large B-cell lymphoma. The patient was initiated on the Pola-R-CHP protocol (Polatuzumab vedotin, Rituximab, Cyclophosphamide, Doxorubicin, Prednisone). Interim PET/CT after three cycles showed a partial metabolic response. This case underscores the pivotal role of multimodality imaging in “unveiling” PCL. The integration of TTE, CCT, CMR, and PET/CT was essential not only for excluding common etiologies like ischemia but also for identifying safe extracardiac biopsy targets, facilitating timely immunochemotherapy.
Aronovich et al. (Mon,) conducted a case report in Primary Cardiac Lymphoma (n=1). Multimodality imaging (TTE, CCT, CMR, PET/CT) was evaluated on Accurate differentiation of cardiac mass and identification of biopsy target. Multimodality imaging integrating TTE, CCT, CMR, and PET/CT successfully diagnosed primary cardiac lymphoma in a 54-year-old female, identifying a safe extracardiac biopsy target.