Korean Circ J.  2011 Sep;41(9):555-558. 10.4070/kcj.2011.41.9.555.

Multimodality Imaging Can Help to Doubt, Diagnose and Follow-Up Cardiac Mass

• Lee SP
• Choi EK
• Kim TM
• Park EA
• Kim HK
• Cho HJ
• Oh S

• KMID: 2094111
• DOI: http://doi.org/10.4070/kcj.2011.41.9.555

Abstract

Primary cardiac lymphoma is a very rare form of lymphoma primarily or mainly involving the heart, as in the two cases presented in this report. Various imaging modalities, including coronary computed tomography angiography, cardiac magnetic resonance imaging and positron emission tomography were useful for the characterization and diagnosis of cardiac mass. Pathologic confirmation was successful with endomyocardial biopsy under echocardiographic guidance, intra- and extracardiacally. In primary cardiac lymphoma, diagnosis using multiple modalities may be useful for mass characterization, and for response monitoring after chemotherapy.

Keyword

Lymphoma; Heart, neoplasm; Echocardiography; Magnetic resonance imaging; Positron emission tomography

MeSH Terms

Angiography
Biopsy
Echocardiography
Follow-Up Studies
Heart
Lymphoma
Magnetic Resonance Imaging
Positron-Emission Tomography

Figure

• 

  Fig. 1 Angiographic and transthoracic echocardiographic findings of cardiac lymphoma at presentation in case 1. A: coronary angiography shows intact right coronary artery (arrows) and AV nodal artery (dotted arrows) without significant stenosis. B: coronary CT angiography shows preservation of the right coronary artery lumen in spite of the mass at the posterior surface and AV groove of the heart (arrowheads). The AV nodal artery was not compromised in both images. C: modified three chamber view by transthoracic echocardiography shows a mass protruding into the right atrium and right ventricle cavity (arrows), which was the target for endomyocardial biopsy. RCA: right coronary artery, AVN a.: atrioventricular nodal artery, RA: right atrium, RV: right ventricle, LV: left ventricle.

• 

  Fig. 2 Cardiac magnetic resonance (CMR) findings of the cardiac lymphoma at presentation (A, upper row) and at follow-up after one cycle of chemotherapy (B, lower row) in case 1. A: iso to slightly high signal intensity mass (arrows) infiltrating the myocardium at the AV groove by steady state free precession (SSFP) image of cardiac MRI (Aa and Ab). Ten-minute delayed MR images with phase-sensitive inversion recovery technique after administration of gadopentetate dimeglumine demonstrated the infiltrative mass (arrows) clearly with heterogeneous enhancement (Ac). B: the mass (dotted arrows) size was markedly reduced after one cycle of chemotherapy in both SSFP (Ba and Bb) and delayed enhancement images with phase-sensitive inversion recovery (Bc). T1 (Ad and Bd) and T2 (Ae and Be) weight images also demonstrate significantly decreased intracardiac mass after chemotherapy.

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  Fig. 3 Transthoracic echocardiography, chest CT and cardiac magnetic resonance findings of the cardiac lymphoma in case 2. A: subcostal view showing a mass in the right atrium (arrows). B: chest CT image demonstrating a hemogeneously attenuated mass in the right atrium (arrows). C: mass infiltrating the posterior surface of the right atrium (arrows) and interatrial septum (dotted arrows) is demonstrated in steady state free precession (a, b and c), T1 (d) and T2 (e) images.

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