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CT AND MRI FINDINGS OF RIGHT
CARDIAC TUMOR REVEALING A
DISSEMINATED LYMPHOMA:
A CASE REPORT
H RIAHI, Y AROUS, M LANDOLSI, S KOUKI, H BOUJEMAA, N BEN ABDALLAH
Radiology Department, Military Hospital of Tunis, Montfleury, Tunis, Tunisia
E mail: [email protected]
CR1
INTRODUCTION
 Metastases to the heart and pericardium are much more
common than primary cardiac tumors and are generally
associated with a poor prognosis.
 In autopsies at which a malignant neoplasm was
diagnosed, cardiac metastases were found in 9.7%–
10.7% of case.
 Tumors that are most likely to involve the heart and
pericardium include cancers of the lung and breast,
melanoma, and lymphoma
HISTORY
 A 30 year old woman presented with acute dyspnea and palpitations.
 A transthoracic echocardiography was performed and showed a mobile
echogenic mass.
 Whole body CT and cardiac MRI were performed.
IMAGING FINDINGS
 Hole body CT (64-section, General Electric)
 Cardiac MR (Siemens Verio 3 Tesla):
Turbo spin-echo T1-weighted before and after contrast
administration images
T2- weighted images (HASTE)
Steady state free precession images
Delayed enhancement images
★
Contrast enhanced CT scan: low
attenuation mass of the right
atrium and ventricle (★) and a
pericardial effusion
Contrast enhanced CT scan: left
retroperitoneal mass ()

Contrast enhanced CT scan:
bilateral ovarian masses

★
Axial T1-weighted image before
administration of gadolinium:
isointense mass of the right
cavities ()and a thickening of the
interatrial septum(★)
Axial T2-weighted image (HASTE):
slightly hyperintense mass of the
right cavities

★
Two-chamber and short-axis steady-state free precession images: mobile mass
occupying almost the entire right cavity and a thickening of the right ventricular
wall()and and the inferior wall of the left ventricle(★)
Axial, two chambers and short axis T1-weighted images after
administration of gadolinium show heterogeneous enhancement
of the right mass and the thickening of the interatrial septum and
the inferior wall of the left ventricle.
Short-axis and two chambers delayed enhanced
sequences: heterogeneous enhancement
 A life-saving emergency operation was carried.
The pathology report with immunostaining
confirmed a diagnosis of B cell lymphoma.
 A CT control showed a significant response to
chemotherapy estimated to 80 %
DISCUSSION
EPIDEMIOLOGIC FEATURES
 Cardiac metastases are far more common than primary
involvement, with an estimated ratio of 30:1.
 In the presence of a malignant tumor, cardiac metastases are
found in 9.7%–10.7% of cases.
 The tumors that most frequently metastasize to the heart and
pericardium are lung and breast cancers, melanomas, and
lymphomas.
Involvement of the heart and pericardium is usually
a late manifestation of lymphoma; the median time
of onset is 20 months after initial diagnosis.
The tumors usually arise from the right side of the
heart, often the right atrium, with frequent
involvement of more than one chamber and are
accompanied by a large pericardial effusion.
In approximately one third of patients with cardiac
involvement, death will be directly attributable to the
metastases as a result of pericardial tamponade,
congestive cardiac failure, or coronary artery
invasion
CLINICAL FEATURES
 Although cardiac metastases from lymphoma are frequently
found at autopsy, they are rarely diagnosed because most
patients (90%) are asymptomatic
 When present, the clinical signs and symptoms of cardiac
metastases are nonspecific and include:
 Fatigue,
 Superior vena cava syndrome,
 Congestive heart failure,
 Cardiac arrhythmia,
Pericardial effusion,
Obstructed right ventricular inflow or outflow,
 Transient ischemic attack
 Arrhythmia remains the most common clinical sign
of cardiac metastases, and its sudden appearance
raises the possibility of cardiac metastatic
involvement.
 Tumor involvement and its consequences (cardiac
tamponade, congestive heart failure, coronary
artery invasion, sinoatrial node invasion) are the
cause of death in one-third of patients with cardiac
metastases.
IMAGING FEATURES
1. CHEST RADIOGRAPHY:
 cardiomegaly
 pericardial effusion
 signs of heart failure
2. ECHOCARDIOGRAPHY:
 Cardiac mass in the right atrium or ventricle
 pericardial effusion
3. CT:
 lymphomas are hypoattenuating or isoattenuating
relative to the myocardium
 heterogeneous enhancement after intravenous
administration of contrast material
4. MR IMAGING:
 poorly marginated and heterogeneous lesions
 lobulated
 isointense to slightly hypointense relative to
cardiac muscle on T1-weighted MR images
 isointense to slightly hyperintense on T2-weighted
images.
 Gadolinium administration produces a
heterogeneous pattern of enhancement.
CONCLUSION
 Metastases to the heart occur late in the course of malignant
disease. The patient typically has metastatic disease at other
sites (usually pulmonary metastases are present).
 Cardiac or pericardial locations are rarely the first sites of
malignant disease.
 Neoplasms with the highest frequency of cardiac and
pericardial metastases include melanoma, leukemia, and
lymphoma.
 Involvement of the heart and pericardium is usually a
late manifestation of lymphoma.
 Our knowledge, it is the first case where a cardiac
mass reveal a disseminated lymphoma.
 The tumor usually arise from the right side of the
heart, often the right atrium, and are accompanied by
a large pericardial effusion.
 MRI is presently the modality of choice to evaluate cardiac
tumors.
 High contrast resolution and multiplanar capability allow a
specific diagnosis and optimal evaluation of myocardial
infiltration, pericardial involvement and extracardiac
extension.
 Acquisition of postcontrast sequences enables better
depiction of tumor vascularity and can be used to
define tumor borders.
 MRI has an important role in differentiating thrombi
from cardiac tumors