Cardiac tamponade as the initial presentation of Hodgkin's lymphoma in a young female

Introduction: Hodgkin's's lymphoma can affect the heart both as primary and as a metastatic condition. Pericardial compromise is a common finding over the course of the disease, and the manifestations can range from pericarditis to pericardial tamponade. Pericardial tamponade is a life-threatening condition that requires immediate treatment; and is rarely the initial presentation of Hodgkin's's lymphoma. We present a case of a young female with Hodgkin's'ss lymphoma initially presenting as acute pericardial tamponade. Case Report: A 20-year-old female presented with acute shortness of breath. At presentation she was hypotensive, tachycardic, and tachypneic. Chest X-ray showed an enlarged mediastinum, without enlarged cardiac silhouette. Bedside transthoracic echocardiography demonstrated massive pericardial effusion with cardiac tamponade. The patient was in critical condition, and a pericardial window was performed. After the procedure she was hemodynamically stable. Positron emission tomography and computed tomography evidenced a ganglionar conglomerate in the mediastinum and supraclavicular area. An excisional biopsy of a neck lymph node confirmed classical Hodgkin's'ss lymphoma. She was started with standard chemotherapy induction. At the time of the report the patient is doing well with favorable response to the treatment, and without any clinical evidence of systemic or cardiac recurrence. Conclusion: Pericardial involvement is frequent over the course of Hodgkin's's lymphoma. Pericardial tamponade is rarely the initial presentation of Hodgkin's's lymphoma. A team approach is necessary for favorable outcome. Treatment consists of stabilizing the patient by relieving the tamponade, followed by systemic chemotherapy treatment for the underlying malignancy and to prevent recurrence.