title: Primary cardiac lymphoma presenting clinically as restrictive cardiomyopathy.
abstract: An unusual case of primary cardiac lymphoma presenting as restrictive cardiomyopathy with arrhythmia is reported in a 72-year-old woman who was admitted for evaluation of exertional dyspnea and palpitations. Electrocardiography (ECG) showed atrioventricular dissociation and right heart cardiac catheterization revealed a typical 'dip-and-plateau' waveform. Restrictive cardiomyopathy was suspected because computed tomography (CT) did not reveal pericardial thickening, calcifications, or an effusion. Heart failure initially improved with diuretic therapy, but subsequently worsened, and the patient experienced a syncopal episode. ECG showed atrial fibrillation, and CT revealed a large mass in the right atrium and multiple tumors in the liver, which needle biopsy confirmed as diffuse large B-cell lymphoma. Chemotherapy induced complete remission, and her heart failure markedly improved. The 'dip-and-plateau' waveform was no longer detected on repeat cardiac catheterization and the ECG showed restoration of sinus rhythm. Clinically, the diagnosis was primary cardiac lymphoma.
authors.affiliation: Department of Cardiology, Showa General Hospital, Tokyo, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Fujisaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Jyundai
authors.initials: J
authors.lastname: Kato
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Saito
authors.forename: Kohei
authors.initials: K
authors.lastname: Yano
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Sada
authors.forename: Kouichi
authors.initials: K
authors.lastname: Kitazume
authors.forename: Akira
authors.initials: A
authors.lastname: Fujita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kira
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D006328:Cardiac Catheterization; D002313:Cardiomyopathy, Restrictive / Q000209:etiology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006327:Heart Block; D006338:Heart Neoplasms / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000175:diagnosis*; D012074:Remission Induction / Q000379:methods; D014057:Tomography, X-Ray Computed