Pericardial constriction due to malignant lymphoma

Area of Science:

• Cardiology
• Oncology
• Pathology

Background:

• Malignant lymphoma, particularly T-cell lymphoma, can have diverse clinical presentations.
• Cardiac involvement in lymphoma is often associated with poor prognosis.

Observation:

• An 81-year-old male presented with dyspnea, fatigue, congestive heart failure, and cervical lymphadenopathy.
• Right heart catheterization showed "dip and plateau" waveforms indicative of constrictive heart failure.
• Gallium scintigraphy revealed significant cardiac uptake, and lymph node biopsy confirmed T-cell lymphoma.

Findings:

• The patient was diagnosed with T-cell lymphoma manifesting as diastolic heart failure.
• Heart failure symptoms persisted despite successful chemotherapy.
• Autopsy confirmed constrictive pericarditis with severe pericardial adhesion.

Implications:

• T-cell lymphoma should be considered in the differential diagnosis of unexplained diastolic heart failure.
• Constrictive pericarditis can be a late manifestation of lymphoma, requiring specific management.
• Early recognition and treatment of cardiac involvement in lymphoma are crucial.