SHM Converge Scientific Abstract ePoster Gallery-Heart Under Pressure: DLBCL Presenting as Isolated Cardiac Tamponade

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A 64-year-old man with apical hypertrophic cardiomyopathy and nonobstructive coronary artery disease presented with worsening exertional chest pain that progressed to rest pain. On arrival, his vital signs were stable, and ECG changes were similar to prior findings, but troponin levels were elevated and rising, so he was initially treated as having acute coronary syndrome.<br /><br />Transthoracic echocardiography, however, revealed a moderate pericardial effusion with tamponade physiology, including right ventricular compression and right atrial inversion. He underwent urgent pericardiocentesis, which drained 75 mL of serosanguineous fluid and led to symptom resolution. Follow-up imaging showed minimal residual effusion and no ongoing tamponade. Cardiac catheterization later demonstrated no significant obstructive coronary disease.<br /><br />Cytologic examination of the pericardial fluid identified an aggressive B-cell non-Hodgkin lymphoma, concerning for diffuse large B-cell lymphoma (DLBCL), with BCL-6 translocation confirmed by FISH. A PET/CT scan showed no FDG-avid lymphadenopathy or evidence of lymphoma elsewhere, making this an unusual case of isolated cardiac involvement without systemic disease. Based on the pericardial fluid diagnosis, the patient was started on pola-R-CHP chemotherapy and continues outpatient oncology follow-up.<br /><br />This case highlights that pericardial effusion with tamponade can be the sole presenting feature of DLBCL. It also emphasizes the importance of considering malignancy in unexplained pericardial effusions and obtaining cytologic analysis promptly, since early diagnosis can lead to timely treatment and help prevent recurrent effusion and other complications.

Asset Subtitle

Navin Bhatt

Meta Tag

Author List Navin Bhatt, Priyesh Thakurathi, Shrija Thapa

Category Clinical Vignettes

Concept Pericardial Effusion

Concept Cardiac Tamponade

Concept Diffuse Large B-Cell Lymphoma

Concept Malignancy

Concept Echocardiography

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai / Elmhurst

Presenting Author Navin Bhatt

Track Adult

Keywords

diffuse large B-cell lymphoma

pericardial effusion

cardiac tamponade

pericardiocentesis

acute coronary syndrome

apical hypertrophic cardiomyopathy

BCL-6 translocation

serosanguineous fluid

PET/CT scan

isolated cardiac involvement

Pericardial Effusion

Cardiac Tamponade

Diffuse Large B-Cell Lymphoma

Malignancy

Echocardiography