title: Coronary sinus obstruction by primary cardiac lymphoma as a cause of dyspnea due to significant diastolic dysfunction and elevated filling pressures.
abstract: A 52-year-old woman presented with severe dyspnea of 2 weeks' duration. Echocardiography showed an enlarged left atrium but normal global left ventricular systolic function. However, a huge, irregularly shaped mass at the dilated coronary sinus that extended into the right atrium was noted. Mitral inflow showed restrictive physiology and the E/E' ratio was significantly elevated, suggesting elevated left ventricular filling pressures. Echocardiography-guided biopsy was performed, and a diagnosis of primary cardiac lymphoma (diffuse large B-cell type) was made. After the first cycle of chemotherapy, the patient's symptom was markedly improved. A follow-up echocardiogram showed complete removal of the mass and a change in left ventricular filling pattern from restrictive to relaxation abnormality with decreased E/E'. The present case demonstrates a rare cause of diastolic dysfunction due to coronary sinus obstruction by tumor infiltration. Diastolic dysfunction caused by coronary sinus obstruction was improved after the tumor was resolved by chemotherapy.
authors: Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Shinchon-dong, 120-752 Seoul, South Korea.
authors: Sang Min
authors: SM
authors: Park
authors: Chi Young
authors: CY
authors: Shim
authors: Donghoon
authors: D
authors: Choi
authors: Ji-Hyun
authors: JH
authors: Lee
authors: Sung Ai
authors: SA
authors: Kim
authors: Eui-Young
authors: EY
authors: Choi
authors: Jong-Won
authors: JW
authors: Ha
authors: Namsik
authors: N
authors: Chung
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D054326:Coronary Sinus; D003520:Cyclophosphamide / Q000008:administration & dosage; D003971:Diastole; D004317:Doxorubicin / Q000008:administration & dosage; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D000069283:Rituximab; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone