Primary cardiac lymphoma: a case report

BACKGROUND: Primary cardiac lymphoma is an extremely rare malignancy involving the heart and pericardium. It is a disease that most commonly effects the right atrium and right ventricle. Left untreated it carries a very poor prognosis. Recent advancements in therapy including early recognition and initiation of chemotherapy has led to improved survival. CASE SUMMARY: A 78 year old female presented with weight loss, abdominal pain and distension. An ultrasound abdomen pre admission showed abdominal ascites. An echocardiogram performed during admission showed a large pericardial effusion with asymmetrical increase in left ventricular wall thickness and a new left atrial mass. Pericardial fluid analysis led to the diagnosis of diffuse large B cell non-Hodgkin's lymphoma. Positron Emission Tomography CT (PET-CT) shows avid fluorodeoxyglucose (FDG) uptake in cardiac muscle. Prompt treatment was initiated with a chemotherapy regimen involving Rituximab, Cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). An echocardiogram 3 months post initiation of treatment showed resolution of the pericardial effusion and left atrial mass as well as an improvement in left ventricular wall thickness. A PET-CT following completion of treatment showed complete metabolic response. DISCUSSION: The diagnosis of primary cardiac lymphoma is uncommon and the presence of left rather than right heart involvement is rarer still. Multimodality imaging is key in diagnosis. Early recognition and treatment is vital in improving associated morbidity and mortality.