Secondary Cardiac Lymphoma Presenting as Effusive–Constrictive Pericarditis

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) may present as effusive constrictive pericarditis. CASE SUMMARY: A 40-year-old woman with relapsed high-grade DLBCL presented with worsening dyspnea and acute decompensated heart failure. Two weeks prior, she underwent a pericardial window with preserved left ventricular ejection fraction of 50%. On admission, transthoracic echocardiography revealed nodular pericardial thickening consistent with metastatic disease and a new reduction in left ventricular ejection fraction to 39%. Doppler imaging revealed expiratory diastolic hepatic vein flow reversal, ventricular interdependence with septal bounce, and annulus reversus with a medial mitral annular e' velocity preserved at 9 cm/s and a reduced lateral e' velocity of 6 cm/s. These findings were diagnostic of effusive-constrictive pericarditis following recent pericardial drainage. DISCUSSION: This case highlights secondary cardiac lymphoma as a rare cause of effusive-constrictive pericarditis and underscores the diagnostic importance of echocardiography. TAKE-HOME MESSAGE: DLBCL-related pericardial involvement carries a poor prognosis with limited therapeutic options.