Cardiac Localizations of Hodgkin Lymphoma: A Case Report

Introduction: Cardiac involvement during Hodgkin lymphoma is rare and is often seen at a late stage of the disease. The diagnosis of cardiac localization is difficult to make while the patient is alive, Transthoracic echocardiography is used to identify cardiac involvement in most cases, but other imaging techniques such as CT or MRI are usually used. Histological evidence is essential for diagnosis and the prognosis of these localizations remains guarded despite advances in the treatment of lymphomas in general. We report a case of cardiac localization of Hodgkin's lymphoma with a pericardial effusion.

Case Report Summary: Mr. L. A, 42 years old, followed for Hodgkin lymphoma in complete remission for 3 years, presented to the emergency room for dyspnea.

On admission, the patient was conscious, heart rate was100 bpm, BP=129/80 mmHg, Cardiac auscultation objective a regular rhythm with muffled heart sounds without signs of right heart failure. The ECG showed a sinusal tachycardia at 100 bpm, with a diffuse micro-voltage and negative T waves in the anteroseptal.

The TTE and CT scan allowed to orientate the etiological diagnosis a by revealing the presence of an voluminous mass in the right ventricle (RV), It was adherent to the free wall of the RV which it infiltrated, without a clear boundary between the healthy myocardium and the tumoral process. It extended into the RV outflow tract with the presence of a second mass in the pulmonary tract and in the trunk of the pulmonary artery C associated with a large circumferential compressive effusion, PET-FDG exploration was performed and it was in favor of a lymphomatous dissemination at the mediastinal level.

After the six course chemotherapy, the myocardial tumor infiltration and pericardial effusion regressed; the general condition improved.

Discussion: Hodgkin's disease is now considered a special type of B lymphoma, characterized by the proliferation of large cells called Reed-Sternberg cells within a characteristically reactive lymphoid tissue.

Cardiac lymphomas, whether primary or secondary, are rare; their clinical manifestations are infrequent and the diagnosis of the cardiac localization is rarely made during the patient's lifetime.

MRI is a relevant technique to study a cardiac mass because of its high signal resolution. high signal resolution. The CT scan offers a less good tissue contrast but because of its high spatial resolution, it allows to better specify the anatomical relationships of the lesion (coronary arteries, pericardium). These 2 examinations can complement each other’s, and allow guided biopsies to be performed in order to confirm the histological nature of cardiac masses.

The 18-FDG PET scan plays an important role in the initial diagnoses and also for the evaluation of the treatment effectiveness.

Treatment usually involves a protocol of the chemotherapy and/without radiotherapy with a generally good evolution.

Final Considerations: Most cases of cardiac lymphoma are aggressive, progress rapidly and often have life-threatening complications such as heart failure and arrhythmia. It is therefore important to diagnose and treat them quickly. Moreover, the prognosis is poor because no clear treatment guidelines have been established.