Oncologic Brugada

Area of Science:

• Cardiology
• Oncology
• Diagnostic Imaging

Background:

• Structural abnormalities of the right ventricular outflow tract (RVOT) can mimic Brugada syndrome, a condition affecting heart rhythm.
• Polymorphic ventricular tachycardia/ventricular fibrillation cardiac arrest presents a critical medical emergency requiring prompt diagnosis.

Purpose of the Study:

• To report a unique case where primary cardiac lymphoma presented with symptoms and electrocardiogram findings suggestive of Brugada syndrome.
• To illustrate the diagnostic challenges and the role of advanced imaging and biopsy in identifying rare cardiac infiltrative processes.

Main Methods:

• Clinical presentation of a 34-year-old woman with cardiac arrest and Brugada type I pattern on ECG.
• Cardiac magnetic resonance imaging (CMR) to assess RVOT structure, identifying tissue thickening and late gadolinium enhancement.
• Histopathological examination of cardiac biopsy to determine the underlying cause of RVOT abnormalities.

Main Results:

• Initial ECG showed a type I Brugada pattern, and CMR revealed significant RVOT thickening with late gadolinium enhancement, consistent with arrhythmogenic right ventricular cardiomyopathy.
• Atypical features in the anteroseptal RVOT raised suspicion for an infiltrative process.
• Cardiac biopsy confirmed the diagnosis of primary cardiac diffuse large B-cell lymphoma.

Conclusions:

• Primary cardiac lymphoma can present as a Brugada syndrome mimic, causing severe ventricular arrhythmias.
• Comprehensive diagnostic evaluation, including advanced imaging and tissue biopsy, is crucial for differentiating infiltrative cardiac tumors from primary cardiomyopathies.
• This case underscores the importance of considering rare infiltrative neoplastic processes in the differential diagnosis of RVOT abnormalities and ventricular arrhythmias.