Umair Muhammad, Zimmerman Stefan L, Fishman Elliot K
Feinberg School of Medicine, Department of Radiology, Northwestern University, 676 N St Clair St, Chicago, IL 60611, USA.
Russell H. Morgan Department of Radiology and Radiological Science,Johns Hopkins Hospital, North Wolfe Street, Baltimore, MD, USA.
Radiol Case Rep. 2022 Apr 19;17(6):2199-2202. doi: 10.1016/j.radcr.2022.02.003. eCollection 2022 Jun.
Myocardial lymphoma can be seen in the setting of primary or secondary involvement, more common in later. Both primary and secondary involvement is usually seen in the setting of diffuse large B cell lymphoma. We describe a case of a 47-year-old man in cardiogenic shock due to refractory ventricular tachycardia (VT) necessitating intubation, extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump with diffuse thickening of the left ventricular myocardium on CTA chest and subtle infiltrative ill-defined perirenal hypodensities with renal enlargement on CT of abdomen and pelvis. Post-processing with cinematic rendering clearly showed improved tissue contrast and/or differentiation with better demarcation of both the myocardial and renal lesions. A myocardial biopsy demonstrated diffuse large B-cell lymphoma (DLBCL). The patient was treated for ventricular tachyarrhythmias, cardiogenic shock, DCBCL, and numerous complications during 6-month long hospitalization with significant improvement of systolic function at discharge. Myocardial lymphoma is an uncommon cardiac malignancy with common CT imaging appearances of multiple circumscribed iso-attenuating masses or diffuse ill-defined infiltrative myocardial thickening. These findings are better assessed with cinematic rendering due to accentuated depth perception and photorealistic appearance of this post processing modality.
心肌淋巴瘤可见于原发性或继发性累及的情况，多见于后者。原发性和继发性累及通常见于弥漫性大B细胞淋巴瘤。我们描述了一例47岁男性，因难治性室性心动过速（VT）导致心源性休克，需要插管、体外膜肺氧合（ECMO）和主动脉内球囊泵，胸部CT显示左心室心肌弥漫性增厚，腹部和盆腔CT显示肾周低密度影呈细微浸润性、边界不清，伴有肾脏增大。电影渲染后处理清楚地显示组织对比度和/或分化得到改善，心肌和肾脏病变的分界更清晰。心肌活检显示为弥漫性大B细胞淋巴瘤（DLBCL）。患者在为期6个月的住院期间接受了室性快速心律失常、心源性休克、弥漫性大B细胞淋巴瘤的治疗，并出现了许多并发症，出院时收缩功能有显著改善。心肌淋巴瘤是一种罕见的心脏恶性肿瘤，常见的CT影像表现为多个边界清晰的等密度肿块或弥漫性边界不清的浸润性心肌增厚。由于这种后处理方式增强了深度感知和逼真的外观，电影渲染能更好地评估这些发现。
