A Rare Case of Cardiac Tamponade Induced by Chronic Lymphocytic Leukemia

Abstract

While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context of chronic hematologic malignancies, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), are rarely observed. A 66-year-old male, with a history of stage IV CLL/SLL, presented with three weeks of worsening edema, orthopnea, and dyspnea. Two days after admission, an echocardiogram revealed a large circumferential pericardial effusion. Given the concern about early signs of pericardial tamponade, the patient underwent emergent pericardiocentesis with the removal of 700 cc of sanguineous fluid. A pericardial biopsy and flow cytometry of the pericardial fluid confirmed the diagnosis of CLL/SLL with pericardial involvement. There were no signs of large cell lymphoma transformation at that point. This rare case demonstrates the importance of considering cardiac complications in CLL/SLL patients who present with worsening edema, orthopnea, and dyspnea.

Keywords: cardiac tamponade; chronic lymphocytic leukemia/small lymphocytic lymphoma; pericardial effusion; pericardial window; pericardiocentesis; transthoracic echocardiography (tte).

Figure 1. Chest x-ray depicting a small bilateral pleural effusion.

Figure 2. EKG showing low-voltage QRS complexes.

Figure 3. Transthoracic echocardiogram depicting a large pericardial effusion.