Usefulness of transesophageal echocardiographic observation during chemotherapy for cardiac metastasis of non-Hodgkin lymphoma complicated with left ventricular diastolic collapse.
A 53-year-old man, who had been treated for penile origin diffuse large B cell type non-Hodgkin lymphoma (NHL), suffered from right femoral pain and dyspnea. Positron emission tomography (PET) revealed abnormal accumulation in his right femur and cardiac segments. Transthoracic echocardiography revealed massive localized pericardial effusion with the collapse of both ventricles and the mass-like echo in the left atrium. We performed emergent pericardiocentesis and diagnosed this case as a recurrence of NHL with cardiac metastasis. With the use of transesophageal echocardiography (TEE), we confirmed the mass-like echo around the inter-atrial septum, which directly invaded to the aortic ring and the right atrial wall. In order to evaluate the effect of chemotherapy, we performed TEE and observed the precise changes of intra-cardiac tumor size. With the use of TEE monitoring, we could select the appropriate chemotherapeutic regimen, and the tumor became smaller and finally diminished. The femoral accumulation detected by PET also disappeared. We experienced a case of cardiac metastasis of NHL complicated with left ventricular diastolic collapse due to the massive localized pericardial effusion. TEE is a useful tool to evaluate precisely the efficacy of chemotherapy for intra-cardiac tumors.
Takaya
Tomofumi
T
Department of Cardiovascular Medicine, Saiseikai Nakatsu Hospital, Kita-ku, Osaka, Japan. toto54@hotmail.com
Takeuchi
Yoshio
Y
Nakajima
Hideto
H
Nishiki-Kosaka
Saori
S
Hata
Katsuya
K
Kijima
Yoichi
Y
Kita
Tomoyuki
T
Ito
Mitsuaki
M
Okamoto
Masashi
M
Nishikawa
Yuji
Y
Seo
Toshihiko
T
Takaoka
Rie
R
Ohta
Kensuke
K
Yodoi
Keiko
K
Kawashima
Seinosuke
S
D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology; D016903:Drug Monitoring / Q000379:methods*; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000000981:diagnostic imaging; D006338:Heart Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000556:secondary*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010412:Penile Neoplasms / Q000473:pathology; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D016896:Treatment Outcome