Shape of the Heart: A 68-Year-Old Man With a Primary Cardiac Non-Hodgkin Lymphoma

      A previously healthy 68-year-old man presented to his primary care physician with a 6-month history of dyspnea on exertion, 50 pounds of body weight loss, and low QRS voltage on electrocardiogram, prompting computed tomography (CT). CT chest scan demonstrated a right ventricular intracardiac mass (2.9 × 2.6 cm; Fig. 1A), massive pericardial effusion, and multiple conglomerated lymphadenopathies in both high and low paratracheal, prevascular, and subcarinal regions. Cytology of 1000 mL of pericardiocentesis revealed a diffuse large B-cell lymphoma. Positron emission tomography-CT showed hypermetabolic activities in the right ventricle and conglomerated mass occupying mediastinum (Fig. 1B), but no disease elsewhere. Bone marrow biopsy was negative for malignancy. Lactate dehydrogenase was slightly more elevated than normal.
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      Fig. 1Diagnostic images at the initial diagnosis. (A) Axial plan of computed tomography image of the chest at diagnosis demonstrates a 2.9 × 2.6 cm right ventricular intracardiac mass (yellow arrow) and pericardial effusion. (B) Positron emission tomography-computed tomography shows hypermetabolic lesions in the right atrium (yellow arrow) and mediastinum (green arrow). (A color version of this figure is available at https://doi.org/10.1016/j.ijrobp.2018.12.024.)
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