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Ischemic heart disease due to compression of the coronary arteries by malignant lymphoma

Yuki Nagasako1, Shun Akaeda, Fumitaka Yanase

  • 1Division of Hematology, St. Luke's International Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|October 16, 2012
PubMed

Insights

A 76-year-old man with angina pectoris was diagnosed with diffuse large B-cell lymphoma. Treatment with chemotherapy relieved coronary artery stenosis and improved heart function, demonstrating lymphoma

Area of Science:

  • Cardiology
  • Oncology
  • Radiology

Background:

  • A 76-year-old male presented with a two-month history of angina pectoris.
  • Initial investigations revealed enlarged lymph nodes compressing major cardiovascular structures.

Observation:

  • Computed tomography (CT) and CT angiography (CTA) demonstrated lymph node enlargement compressing the heart, pulmonary artery, and aorta.
  • CTA revealed coronary artery stenosis secondary to extrinsic compression.
  • Cardiac magnetic resonance imaging (MRI) indicated myocardial ischemia due to a perfusion defect.

Findings:

  • Diffuse large B-cell lymphoma was diagnosed as the underlying cause.
  • Multidrug chemotherapy resulted in prompt symptomatic improvement.
  • Follow-up imaging confirmed relief of coronary artery stenosis and improved myocardial perfusion.

Implications:

  • This case highlights the importance of considering extrinsic compression from lymphoma in the differential diagnosis of coronary artery stenosis and myocardial ischemia.
  • Effective chemotherapy can reverse cardiovascular compromise caused by lymph node enlargement.
  • Integrated imaging modalities (CT, CTA, MRI) are crucial for diagnosis and monitoring treatment response.

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