Constrictive Pericarditis-A Cloak Camouflaging Lymphoma

Abstract

Non-Hodgkin's lymphoma presenting as a primary cardiac lymphoma (PCL) is extremely unusual. Having a predilection for the right side of the heart and accounting for 1% of all cardiac tumours, the difficulty in diagnosing the lesion, owing to the location and vague presenting symptoms and signs, often leads to delayed diagnosis and poor prognosis. In our case report, a middle-aged male was diagnosed with PCL presenting as pyrexia of unknown origin with the help of F18-fluorodeoxyglucose positron emission tomography (18 FDG-PET). PET-CT is an invaluable tool in patients with pyrexia of unknown origin (PUO), especially caused by neoplasms as it helps in localizing the target lesion, aiding in selecting the appropriate intervention for rapid tissue diagnosis. This case serves to sensitize the physicians of PCL presenting with PUO and mimicking a relatively common cardiac tumour such as atrial myxoma.

Keywords: FDG PET-CT scan; constrictive pericarditis; diagnostic challenge; diffuse large B cell lymphoma; primary cardiac lymphoma.

Figure 1

Mediastinal axial view of the thorax showing pericardial thickening and heterogeneous area protruding from anterior visceral pericardium and bulging partially into right atrium and tricuspid valve region.

Figure 2

(A) Maximum intensity projection (MIP) image of 18FDG PET-CT scan showing increased uptake of FDG around the cardia, neck, axillary, and inguinal nodes. (B) Axial and coronal sections showing increased uptake by the lesion, surrounding cardia, and great vessels.

Figure 3

Histopathology findings of lymph node. (A) Effacement of lymph node architecture by atypical lymphoid cells (H&E stain, 4×). (B) Large RS-like cell with multilobated nucleus (H&E stain, 40×). (C) Expression of CD20 in atypical lymphoid cells (IHC, 20×).