Author + information
- Received May 19, 2011
- Revision received June 2, 2011
- Accepted June 14, 2011
- Published online December 6, 2011.
- Sean R. Wilson, MD⁎,
- John P. Leonard, MD†,
- Julia T. Geyer, MD‡,
- Joseph R. Osborne, MD, PhD§ and
- Jonathan W. Weinsaft, MD⁎,§
A 59-year-old woman with known enteropathy-associated T-cell lymphoma (EATL) presented with weakness and malaise. An electrocardiogram demonstrated sinus tachycardia, right bundle branch block, and anterior ST-segment elevations (A). Cardiac catheterization showed patent coronary arteries (B, Online Videos 1 and 2). Echocardiography and cine cardiac magnetic resonance imaging (MRI) demonstrated asymmetric septal hypertrophy (Online Videos 3 and 4), whereas delayed-enhancement cardiac MRI tissue characterization showed patchy epicardial and mid-myocardial hyperenhancement, suggestive of hypertrophic cardiomyopathy (C).
Positron emission tomography (PET) revealed marked hypermetabolic activity in the interventricular septum, corresponding to regional hyperenhancement on MRI (D). Subsequent cardiac septal biopsy (E) demonstrated infiltration by atypical lymphocytes with irregular nuclear contour and prominent nucleoli; T-cell morphology was identical to that found in patient's prior bone marrow biopsy.
EATL, an intestinal tumor of intraepithelial T lymphocytes, is a rare, aggressive disease. Whereas PET is used to stage EATL, no prior reports have documented cardiac involvement on PET or MRI. This case demonstrates the importance of integrated metabolic and tissue characterization imaging for cardiomyopathy assessment.
- Received May 19, 2011.
- Revision received June 2, 2011.
- Accepted June 14, 2011.
- American College of Cardiology Foundation