Massive Cardiac Infiltration Revealing a Diffuse B-cell Lymphoma
Y. Boudjemline, MD; D. Bonnet, MD; D. Sidi, MD.
Service de Cardiologie Pédiatrique, Hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75015 Paris Cedex, France
A 15-year-old girl was admitted to our hospital with fatigue, weight loss, cough and cardiac murmur. Physical examination revealed multiple skin nodules on her back. Cardiac auscultation revealed the presence of a systolic murmur. There were no signs of cardiac failure. A 12-lead electrocardiogram demonstrated sinus rhythm with a moderate prolongation of the QT interval (QT corrected for heart rate, 0.5 sec). Chest X-ray showed mediastinal and cardiac enlargement. On transthoracic echocardiography, the myocardium was seen to be massively infiltrated by multiple thick masses with high echogenicity (figure). The right atrioventricular area, the interventricular and interatrial walls were all thickened and appeared echodense. Global systolic function was preserved. The diagnosis of lymphoma, suspected on standard histology of a surgical skin biopsy, was confirmed by immunohistochemical analysis of paraffin-embedded sections. Extracardiac exploration revealed the involvement of multiple abdominal and mediastinal lymph nodes. The patient is currently undergoing medical treatment with chemotherapic agents.
Figure legend
Figure. 2D echocardiography on admission showing massive infiltration of the myocardium by multiple masses with high echogenicity.
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