Cardiac involvement with lymphoma: a review of the literature

Abstract

Current literature suggests that the incidence of cardiac involvement by lymphoma as identified by autopsy varies widely, ranging from 8.7% to 20%. Historically, many cases might have been clinically undetected; however, improved imaging techniques increasingly identify cardiac involvement incidentally. In addition, newer agents resulting in improved cancer therapy outcomes might alter the prevalence and location of metastatic deposits to include more unusual disease sites, including intracardiac locations. We present 2 cases and a review of the literature.

Figure 1. Computed Tomography Images at Initial Review (Left) and After 2 Cycles of Bortezomib/EPOCH Therapy (Right) Demonstrating Complete Resolution of the Left Intraventricular Septal Wall Mass

Abbreviations: EPOCH = infusional etoposide/vincristine plus doxorubicin/cyclophosphamide/prednisone; IVS = intraventricular septum

Figure 2. Cardiac MRI Scans Before and After Intravenous Contrast Identifies a Solitary Cardiac Metastasis

The image on the right is from a cine MRI scan in a 4-chamber view using a steady-state free precession technique. Note that the basal lateral wall is focally hypertrophied or thicker than other walls of the LV (arrows). This localization is atypical for familial hypertrophic cardiomyopathy or other secondary hypertrophic processes. Delayed-enhancement images (on the left) obtained 20 minutes after administration of gadolinium contrast using an inversion recovery gradient echo technique validated for imaging myocardial infarction. The region of localized hypertrophy in the basal lateral wall shows a surrounding region of enhancement (white), while the core of the mass is much darker than the surrounding tissue, suggesting low perfusion or low contrast accumulation. The findings are consistent with metastasis to the heart. Abbreviations: LA = left atrium; MRI = magnetic resonance imaging; RA = right atrium; RV = right ventricle