{"title":"心脏原发性弥漫大 B 细胞淋巴瘤--一例罕见的心力衰竭病例。","authors":"Mariana Martinho , Liliana Brochado , Bárbara Marques Ferreira , Susana Guimarães , Ana Rita Almeida , Hélder Pereira","doi":"10.1016/j.carpath.2024.107664","DOIUrl":null,"url":null,"abstract":"<div><p>A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.</p></div>","PeriodicalId":9451,"journal":{"name":"Cardiovascular Pathology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary diffuse large B-cell lymphoma of the heart: A rare case of heart failure\",\"authors\":\"Mariana Martinho , Liliana Brochado , Bárbara Marques Ferreira , Susana Guimarães , Ana Rita Almeida , Hélder Pereira\",\"doi\":\"10.1016/j.carpath.2024.107664\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.</p></div>\",\"PeriodicalId\":9451,\"journal\":{\"name\":\"Cardiovascular Pathology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-05-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Pathology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1054880724000607\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Pathology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1054880724000607","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
一名 65 岁的男性因出现右心衰竭症状和体重明显减轻而入院,他既往有吸烟史、艾滋病感染控制史、乙型肝炎感染治疗史和 III 型冷球蛋白血症史。尽管血流动力学稳定,但他出现过 1:1 传导性心房扑动,并伴有呼吸性碱中毒和代谢性酸中毒,以及急性肝肾功能障碍、D-二聚体和心脏标志物升高。他接受了胸部计算机断层扫描和超声心动图检查,结果证实了肺栓塞,最明显的是发现了一个巨大的心脏肿块,几乎完全阻塞了右心室,与心肌壁和三尖瓣之间没有裂隙。心脏磁共振检查高度提示恶性肿瘤。考虑进行心脏手术切除肿块和心内膜活检确诊,但患者因对药物治疗无反应而死于梗阻性休克。尸检显示为原发性不明弥漫大B细胞淋巴瘤。
Primary diffuse large B-cell lymphoma of the heart: A rare case of heart failure
A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.
期刊介绍:
Cardiovascular Pathology is a bimonthly journal that presents articles on topics covering the entire spectrum of cardiovascular disease. The Journal''s primary objective is to publish papers on disease-oriented morphology and pathogenesis from clinicians and scientists in the cardiovascular field. Subjects covered include cardiovascular biology, prosthetic devices, molecular biology and experimental models of cardiovascular disease.