成功化疗治疗右心室淋巴瘤导致的三尖瓣狭窄患者

Do Van Chien, Tran Quoc Quy
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摘要

背景:本研究介绍了一名因右心室淋巴瘤导致三尖瓣狭窄并成功接受治疗的患者。病例介绍:一名 66 岁的男性患者在过去三周内出现活动时气喘加重的病史,于是就医。患者后来出现四肢浮肿、肺部周围积液和腹部积液,但未报告胸痛、发热或体重减轻。超声心动图检查发现,右心室三尖瓣附近的侧壁有肿块,导致三尖瓣中度狭窄。心脏磁共振成像(MRI)显示,肿块呈块状,轮廓不清,侵犯心肌,造影剂照射后显示不同程度的增强。根据其特征和造影剂吸收能力,怀疑是恶性肿瘤或转移性病变。为了确诊,医生对右心室的肿块进行了经皮活检。病理报告显示,诊断结果为非霍奇金淋巴瘤。确诊后,患者接受了 R-CHOP 方案化疗。随着时间的推移,患者的症状有所改善,超声心动图显示肿瘤缩小。在接受了六轮化疗后,四个月后的心脏核磁共振检查显示肿瘤已不复存在。此后,患者恢复了正常活动。结论右心室肿瘤多为恶性病变,预后往往较差。有必要利用成像技术和心肌活检进行早期诊断,以便迅速提供挽救生命的治疗。
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Successful chemotherapy treatment for a tricuspid valvular stenosis patient due to right ventricular lymphoma
Background: This study presents a patient diagnosed with tricuspid valvular stenosis due to right ventricular lymphoma, who was treated successfully. Case presentation: A 66-year-old man with a history of worsening shortness of breath during activity for the last three weeks sought medical attention. The patient later experienced swelling in the extremities, fluid build-up around the lungs and abdominal fluid accumulation, with no reported chest pain, fever, or weight loss. An echocardiogram found a mass in the lateral wall near the tricuspid valve of the right ventricle, leading to moderate tricuspid stenosis. The cardiac magnetic resonance imaging (MRI) revealed a lumpy, poorly defined mass that invaded the heart muscle and displayed varied enhancement after contrast administration. Suspicion arose for a malignant tumour or metastatic lesion due to its features and contrast uptake capability. A percutaneous biopsy was carried out on the mass in the right ventricle to confirm the diagnosis. The pathology report indicated a diagnosis of non-Hodgkin’s lymphoma. After being diagnosed, the patient underwent chemotherapy using the R-CHOP regimen. Over time the symptoms improved, and echocardiograms revealed a decrease in the size of the tumour. After undergoing six rounds of chemotherapy, a cardiac MRI four months later showed no signs of a tumour. After that, the patient resumed their regular activities. Conclusion: Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis. Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly.
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