Pericardiocentesis yielding 450 cc of fluid, followed by colchicine and R-CHOP chemotherapy, was used to manage a 22-year-old male with effusive-constrictive pericarditis and large B-cell lymphoma.
Case Report (n=1)
Effusive-constrictive pericarditis is a rare but critical manifestation of primary mediastinal large B-cell lymphoma that requires prompt recognition and management.
Abstract Background The presence of effusive-constrictive pericarditis (ECP) in the context of malignancies, especially large B-cell lymphoma is rare. Recognizing this presentation is crucial due to its life-threatening nature, as the combination of ECP and cardiac tamponade can cause severe hemodynamic instability in patients. Case Summary A 22-year-old male presented to the emergency department with a one-month history of progressively worsening shortness of breath, night sweats, anorexia, 15 pounds weight loss and palpitations. Laboratory findings revealed elevated white blood cell count, LDH, D-dimer, lactic acid, and ESR. CT scan confirmed a large anterior mediastinal mass, a large pericardial effusion, and moderate sized pleural effusions bilaterally. Echocardiography confirmed the large pericardial effusion, prompting urgent pericardiocentesis which yielded 450 cc fluid. Next morning, he redeveloped chest discomfort and tachycardia. Repeating echocardiography redemonstrated moderate-sized pericardial effusion with extensive loculation, fibrinous material, early diastolic collapse, respiratory variation in mitral inflow, pointing towards ECP with possible tamponade. The patient was started on colchicine and transferred to a tertiary care hospital for further management. Follow-up echocardiograms over there kept showing partly organized focal pockets of pericardial effusion with a small area of echogenic material but no hemodynamic instability. Biopsy, taken from the anterior mediastinal mass confirmed the diagnosis of primary mediastinal large B-cell lymphoma and he was started on of R-CHOP chemotherapy. Conclusion ECP is an uncommon but critical manifestation of primary mediastinal large B-cell lymphoma. Combination of large pericardial effusion with constrictive features and persistent non-compliant pericardium with elevated intracardiac pressures after pericardiocentesis are its hallmarks.
Kiyani et al. (Wed,) conducted a case report in Effusive-constrictive pericarditis and primary mediastinal large B-cell lymphoma (n=1). Pericardiocentesis, colchicine, and R-CHOP chemotherapy was evaluated. Pericardiocentesis yielding 450 cc of fluid, followed by colchicine and R-CHOP chemotherapy, was used to manage a 22-year-old male with effusive-constrictive pericarditis and large B-cell lymphoma.