Xie Dongmei, Li Yudan, Tang Chunyong, Zou Qing
Department of Radiology, People's Hospital of Deyang City, Deyang, Sichuan, China.
Front Oncol. 2025 Jul 4;15:1596237. doi: 10.3389/fonc.2025.1596237. eCollection 2025.
This study aimed to further enhance the understanding of the imaging features of primary cardiac lymphoma (PCL), improve preoperative diagnostic accuracy, and reduce the misdiagnosis rates.
This study reports on a case of a 63-year-old man who presented with 3-day-long dizziness and bilateral lower limb edema. Initial transthoracic echocardiography detected a 4.5-cm × 5-cm mass without blood flow in the right atrium, suspected as a thrombus or tumor. Subsequently, cardiac MRI (3.0T Ingenia, Philips, Best Netherlands) was performed. Pre-contrast black blood turbo spin echo (TSE) T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), T2 fat saturation (STIR), and retrospective ECG-triggered balanced turbo field echo (steady-state free precession) sequences on short and long axes were used.
MRI showed a roundish solid mass in the right atrium with clear margins, broad-based attachment to the anterior/posterior walls, adjacent right atrial wall thickening, inferior vena cava inlet narrowing, and protrusion into the tricuspid orifice during atrial systole. First-pass perfusion presented homogeneous progressive enhancement, while the delayed phase showed patchy irregular enhancement. Due to limited knowledge about PCL, a preliminary diagnosis of cardiac myxoma was made. Eventually, tumor resection was carried out, and postoperative pathology confirmed it as right atrial diffuse large B-cell lymphoma (DLBCL) with a Ki-67 proliferation index of 90%. Although the symptoms improved post-surgery, the patient refused further chemotherapy and died shortly.
This case highlights that MRI plays a significant role in the diagnosis of PCL, helping to identify characteristic imaging features and reduce misdiagnosis. Preoperative biopsy is crucial for accurate diagnosis, and chemotherapy is essential for improving patient survival. Further research is needed to better understand the imaging features of this rare tumor and optimize treatment strategies.
本研究旨在进一步加深对原发性心脏淋巴瘤（PCL）影像学特征的理解，提高术前诊断准确性，降低误诊率。
本研究报告了一例63岁男性患者，出现长达3天的头晕和双侧下肢水肿。初始经胸超声心动图检测到右心房有一个4.5厘米×5厘米无血流信号的肿块，怀疑为血栓或肿瘤。随后进行了心脏磁共振成像（3.0T Ingenia，飞利浦，荷兰贝斯特）检查。使用了预增强黑血快速自旋回波（TSE）T1加权成像（T1WI）、T2加权成像（T2WI）、T2脂肪抑制（STIR）以及短轴和长轴上的回顾性心电图触发平衡快速场回波（稳态自由进动）序列。
磁共振成像显示右心房有一个圆形实性肿块，边界清晰，基底部附着于前/后壁，相邻右心房壁增厚，下腔静脉入口变窄，心房收缩期突入三尖瓣口。首次通过灌注呈现均匀渐进性强化，延迟期显示斑片状不规则强化。由于对PCL了解有限，初步诊断为心脏黏液瘤。最终进行了肿瘤切除术，术后病理证实为右心房弥漫性大B细胞淋巴瘤（DLBCL），Ki-67增殖指数为90%。尽管术后症状有所改善，但患者拒绝进一步化疗，不久后死亡。
本病例突出了磁共振成像在PCL诊断中发挥的重要作用，有助于识别特征性影像学表现并减少误诊。术前活检对于准确诊断至关重要，化疗对于提高患者生存率必不可少。需要进一步研究以更好地了解这种罕见肿瘤的影像学特征并优化治疗策略。
