Chattranukulchai Pairoj, Puwanant Sarinya, Rungpradubvong Voravut, Singhatanadgige Seri, Boonyaratavej Smonporn
Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Heart Lung Circ. 2014 Jul;23(7):e160-3. doi: 10.1016/j.hlc.2014.03.004. Epub 2014 Mar 14.
Primary cardiac lymphoma is very rare, and usually manifests after the fifth decade of life. The lack of typical manifestations makes it difficult to diagnose at an early stage that can be discovered only by echocardiography. The location of the tumour often results in cardiac compromise, which prevents the delivery of potentially curative therapies. Clinical presentations may depend on flow obstruction, infiltration of adjacent tissues, tumour embolisation, and atrioventricular (AV) disturbances. We report a rare case of primary cardiac lymphoma that presented with clinical signs of shock from two distinct mechanisms. The first mechanism was intermittent complete AV block that was caused by disruption of the electrical conduction system from tumour infiltration in addition to direct mechanical compression of the atrioventricular node by the tumour. The second mechanism, subtotal RV inflow obstruction from the bulky mass contributed to compromising venous return, which played a major role of refractory shock in this case.
原发性心脏淋巴瘤非常罕见，通常在50岁以后出现。缺乏典型表现使得早期诊断困难，早期仅能通过超声心动图发现。肿瘤的位置常常导致心脏功能受损，从而妨碍进行可能治愈性的治疗。临床表现可能取决于血流阻塞、邻近组织浸润、肿瘤栓塞以及房室干扰。我们报告一例罕见的原发性心脏淋巴瘤病例，该病例因两种不同机制出现休克的临床体征。第一种机制是间歇性完全性房室传导阻滞，这是由于肿瘤浸润破坏了电传导系统，此外肿瘤还直接机械性压迫房室结。第二种机制是巨大肿块导致右心室流入道部分梗阻，这导致静脉回流受损，在该病例中这是难治性休克的主要原因。
