Author + information
- Received December 27, 2013
- Accepted January 7, 2014
- Published online February 10, 2015.
- ∗Blumh Cardiovascular Institute, Northwestern University, Chicago, Illinois
- †Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- ‡Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
- §Department of Pathology, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. James D. Thomas, Bluhm Cardiovascular Institute, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, Illinois 60611.
Complete heart block developed in a 70-year-old woman for which a pacer was inserted at an outside institution. Two months later, increasing dyspnea prompted admission with severe jugular venous distention and hepatic enlargement. Transthoracic echocardiography demonstrated massive soft-tissue infiltration of the heart (right ventricular [RV] inflow view [Figure 1A, Online Video 1] and apical 2-chamber view [Figure 1D, Online Video 2] with severe RV inflow obstruction [Figures 1B and 1C, Online Video 3] and tricuspid gradient 33/17 mm Hg). Computed tomography confirmed findings, with right coronary artery encasement (Figure 1E, Online Video 4). Open biopsy demonstrated probable cardiac lymphoma. With full characterization several days off and worsening shock, an empiric dose of 100 mg prednisone was administered with rapid symptomatic improvement. Echocardiography performed <24 h later demonstrated marked regression of the tumor mass with a decrease in tricuspid valve gradient to 14/7 mm Hg (Figures 1F, to 1H, Online Videos 5 and 6). Pathology ultimately showed lymphoma (Figures 1I and 1J) with B-cell (Figure 1K) but not T-cell (Figure 1L) markers. Treatment with R-CHOP led to complete remission of the lymphoma, although with persistent severe TR.
JACC is publishing 3 “Images in Cardiology” articles in this issue. These manuscripts were accepted prior to the current editorial administration. Please note that they are no longer a standard manuscript type that will be acceptable by the Journal.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 27, 2013.
- Accepted January 7, 2014.
- American College of Cardiology Foundation