title: AIDS-related primary cardiac lymphoma with right-sided heart failure and high-grade AV block: insights from magnetic resonance imaging.
abstract: A 44-year-old patient, with personal history of AIDS, was referred to our emergency unit with tachycardia and moderate signs of right-sided heart failure. The cardiac MRI study showed an impairment of the right ventricular free and inferior wall and the interventricular septum. The mass was characterized by notable heterogeneity with mixed areas of hypo- and hypersignal intensity in SSFP and T2-weighted images with fat saturation. There was global hyperenhancement of the mass after gadolinium contrast injection on T1-weighted images with and without fat saturation. The entire right coronary artery was included into the infiltrative mass. One day after the admission, the patient suddenly presented a paroxysmal third degree atrioventricular block, permanently corrected by an implanted cardiac pacemaker. Endomyocardial biopsy conformed the diagnosis of B-cell lymphoma. The patient died 4months after the diagnosis of acute heart failure with multi-organ dysfunction, after a short period of improvement under chemotherapy. We present this case to highlight the importance to consider that a large, solitary, right atrial mass in conjunction with pericardial effusion in a patient with HIV infection should lead to consider, as soon as possible, the diagnosis of lymphoma. MRI has explained the conduction disorders by showing the septal extension of the mass, and by demonstrating right coronary artery involvement.
authors.affiliation: Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France. Electronic address: jllitjos@gmail.com.
authors.forename: J-F
authors.initials: JF
authors.lastname: Llitjos
authors.affiliation: Cardiovascular imaging, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Redheuil
authors.affiliation: Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Vedrenne
authors.affiliation: Cardiology intensive care unit, hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75015 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D054537:Atrioventricular Block / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003287:Contrast Media; D017147:Defibrillators, Implantable; D017809:Fatal Outcome; D005682:Gadolinium; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006338:Heart Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D010138:Pacemaker, Artificial; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; D005682:Gadolinium
keywords: Cardiac lymphoma; Cardiomyopathie; Décompensation cardiaque; Heart failure; Imagerie par résonance magnétique; Lymphome cardiaque; Magnetic resonance imaging; Myocardial cardiomyopathy disease