Author + information
- Received December 13, 2012
- Revision received January 22, 2013
- Accepted February 5, 2013
- Published online August 13, 2013.
A 37-year-old man with a history of non-Hodgkin’s lymphoma presented with fatigue, weight loss, and worsening anorexia. Due to a transient ischemic attack an echocardiogram was obtained demonstrating flow convergence across the right ventricular (RV) inflow tract (A, Online Video 1), an elevated diastolic gradient across the tricuspid valve (B), and no collapse of the inferior vena cava (IVC) (C). Evaluation with a contrast bubble study showed that upon injection of contrast to the forearm, contrast arrived in the left atrium (LA) and ventricle prior to the right atrium (RA) and ventricle (D, Online Video 2). Contrast-enhanced computed tomography confirmed obstruction of the superior vena cava (SVC) (E, arrow) by a large RA mass (E, star). Contrast reached the IVC via collateral flow from the azygous and hemiazygous veins, directly to the left upper pulmonary vein (LUPV) (F, G) consistent with the echocardiographic findings of flow going from the SVC into the LA prior to the RA. Therapy with systemic chemotherapy for recurrence of lymphoma was initiated with a good response and improvement in the patient’s symptoms. LV = left ventricle.
Dr. Beigel is a recipient of a fellowship grant from the American Physicians' Fellowship for Medicine in Israel. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 13, 2012.
- Revision received January 22, 2013.
- Accepted February 5, 2013.
- American College of Cardiology Foundation