Pericardial Diffuse Large B-Cell Lymphoma Diagnosed Via Computed Tomography–Guided Biopsy

Figures

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  Figure 1. 12-Lead Electrocardiogram on Admission A 12-lead electrocardiogram showing sinus rhythm, low voltage in the limb leads, and T-wave inversions in leads V1 to V3.

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  Figure 2. Initial Transthoracic Echocardiography Imaging reveals a mass attached to the right atrium and right ventricle (red arrows) and pericardial effusion in the pericardial cavity. (A) Parasternal long-axis view and (B) parasternal long-axis view.

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  Figure 3. Contrast-Enhanced Computed Tomography Imaging reveals a mass measuring 60 × 35 × 90 mm in the pericardial cavity along the anterior wall of the right atrium and right ventricle, without extension into the cardiac chambers (red arrows) and surrounding the right coronary artery (blue arrows); despite that, blood flow was preserved. (A) Axial view. (B) Sagittal view. (C) Coronal view.

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  Figure 4. Cardiac Magnetic Resonance The mass (red arrows) shows heterogeneous, indeterminate enhancement on 4-chamber late gadolinium enhancement image (A) and variable intensity on short-axis fat-suppressed T2-weighted image (B).

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  Figure 5. Computed Tomography–Guided Biopsy of Pericardial Tumor Under local anesthesia, 3 samples were obtained using an 18-gauge biopsy needle via the left lower parasternal approach. The procedure was completed without any complications.

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  Figure 6. Histologic and Immunohistochemical Assessment of Computed Tomography–Guided Biopsy Round cell tumor in the pericardium. (A) Hematoxylin and eosin staining. (B) High CD20 expression and (C) high CD79a expression (original magnification, 40×).

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  Figure 7. Changes in Tumor Size on Transthoracic Echocardiography The pericardial tumor (red arrows), which measured 35 × 30 mm at admission (A), decreased in size to 25 × 15 mm at discharge (B) after 2 cycles of chemotherapy.