Multimodality Imaging Guided Diagnosis and Treatment Response Evaluation in a Patient with Lymphoma with Right...

A 42-year-old female was transferred to our center from a regional hospital with 5-day history of flushing, fatigue, and chest pressure. On initial presentation to the regional hospital, computed tomography of chest revealed a large mediastinal mass with cardiac involvement. Supraclavicular lymph node biopsy demonstrated nongerminal center diffuse large B-cell lymphoma with Ki67 index near 100%. A transthoracic echocardiogram revealed a solid mass infiltrating the right atrium (RA) and right ventricle (RV), moderate tricuspid regurgitation, and a moderate pericardial effusion. Further assessment with cardiac magnetic resonance imaging demonstrated a contrast avid mass with necrotic center invading into the RA and RV consistent with metastatic lymphoma. Prior to induction chemotherapy, her clinical course was complicated by supraventricular tachycardia that resolved after initiation of targeted chemotherapy against the lymphoma. Follow-up cardiac imaging 3 months later demonstrated decrease in size of the cardiac mass and the amount of pericardial effusion. This case demonstrates utility of multi-modality cardiac imaging in the diagnosis and assessing therapeutic response of diffuse large B-cell Lymphoma with cardiac involvement.