Grohs Ilona, Riedl Katharina, Kliment Christa, Delle-Karth Georg
Department of Internal Medicine, Klinik Oberwart, Dornburggasse 90, Oberwart 7400, Austria.
Department of Cardiology, Klinik Floridsdorf, Brünnerstraße 68, Vienna 1210, Austria.
Eur Heart J Case Rep. 2024 Dec 13;9(1):ytae663. doi: 10.1093/ehjcr/ytae663. eCollection 2025 Jan.
Cardiac lymphoma is a rare disease that can present in various ways. Additionally, atypical clinical presentation makes the diagnosis even more challenging. The most common type of cardiac lymphoma is diffuse large B-cell lymphoma. With chemotherapy, the median survival rate can be up to 2 years. In this report, we focus on the diagnostic approach and differential diagnosis.
A 56-year-old patient presented with complete heart block and B-symptoms. Implantation of a pacemaker (PM) was initially deferred due to a junctional rhythm (50 b.p.m.). Echocardiography showed thickening of the left heart with small pericardial effusion. For better visualization of the extent and infiltration cardiac magnetic resonance imaging and computer tomography (CT) were performed. In addition to the cardiac mass, enlarged mediastinal lymph nodes were found on staging CT scan, prompting a transbronchial biopsy. Histology revealed diffuse large B-cell non-Hodgkin lymphoma. The patient was referred to a hospital with a Hemato-oncology Department for initiation of chemotherapy.
Cardiac lymphoma can be a rare cause of complete heart block. Prior to PM implantation, basic echocardiography is important. In rare conditions like cardiac lymphoma, multimodal imaging, and interdisciplinary decision-making are crucial for management. In the future, lead-less pacemakers could be a safe and effective option for oncology patients.
心脏淋巴瘤是一种罕见疾病，可呈现多种表现形式。此外，非典型临床表现使诊断更具挑战性。最常见的心脏淋巴瘤类型是弥漫性大B细胞淋巴瘤。通过化疗，中位生存率可达2年。在本报告中，我们重点关注诊断方法和鉴别诊断。
一名56岁患者出现完全性心脏传导阻滞和B症状。最初因交界性心律（50次/分钟）而推迟植入起搏器（PM）。超声心动图显示左心增厚并伴有少量心包积液。为更好地观察病变范围和浸润情况，进行了心脏磁共振成像和计算机断层扫描（CT）。除心脏肿块外，分期CT扫描发现纵隔淋巴结肿大，遂进行经支气管活检。组织学检查显示为弥漫性大B细胞非霍奇金淋巴瘤。该患者被转诊至设有血液肿瘤科的医院开始化疗。
心脏淋巴瘤可能是完全性心脏传导阻滞的罕见病因。在植入起搏器之前，基本的超声心动图检查很重要。在心脏淋巴瘤等罕见情况下，多模态成像和跨学科决策对治疗至关重要。未来，无导线起搏器可能是肿瘤患者的一种安全有效的选择。
