Massive myocardial infiltration by HIV-related non-Hodgkin lymphoma: Echocardiographic aspects at diagnosis and at follow-up

Chiara Lestuzzi, Michele Spina, Ferdinando Martellotta, Antonino Carbone

Research output: Contribution to journalArticle

Abstract

A 23-year-old male presented with severe rest dyspnoea, engorged jugular veins, ankle oedema and heart rate 140 bpm. Computed tomography (CT) scan showed a large mediastinal mass with pericardial and atrial infiltration, pulmonary artery and superior vena cava compression. HIV infection was detected. Echocardiography showed 5×4cm masses both in the right and the left atria, pericardial effusion, thickening of the right and left ventricular walls and hypokinesis; after intravenous contrast medium (SonoVue), the ventricular myocardium showed an increased, granular echogenicity, as did the mediastinal mass and pericardium. Nadroparin, bisoprolol, amiodarone and (suspecting non-Hodgkin lymphoma) steroids were started. After 3 days, at echocardiogram, the thickness of the ventricular walls was reduced and ejection fraction was improved. Mediastinal biopsy disclosed a large B-cell lymphoma. After starting systemic chemotherapy (rituximab, cyclophosphamide, vincristine, doxorubicin) and highly active antiretroviral therapy (HAART), 11 days after admission the patient was in New York Heart Association (NYHA) class 1-2, with normal jugular veins and no oedema. The echocardiogram showed no more pericardial effusion, atrial masses reduced by 50%, normal interventricular septum thickness and ejection fraction. In August 2010, after six cycles of chemotherapy followed by radiotherapy, the patient was in complete remission. This case shows both the echocardiographic findings typical of neoplastic infiltration of the myocardium and the rapid improvement observed within a few days after chemotherapy. In the HAART era patients with HIV-related lymphoma and even massive involvement of the heart may receive aggressive treatment with curative intent. Echocardiography is useful in early assessment of the response to therapy.

Original languageEnglish
Pages (from-to)836-838
Number of pages3
JournalJournal of Cardiovascular Medicine
Volume13
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • AIDS
  • cardiac lymphoma
  • cardiac tumours
  • contrast echocardiography
  • echocardiography
  • myocardial infiltration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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