Lymphoma – ABC CARDIOL

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Case Report

Echocardiographic Assessment During Treatment of Acquired Pulmonary Artery Stenosis Due to Mediastinal Mass Compression: A Case Report

Carolynne Ferreira Machado et al. Patrick Ventorim Costa Ana Carolina Main Lucas Fernando Luiz Torres Gomes … Fabricio Thebit Bortolon Laira Bernabe Mota Karllayno Camatta Milleri

Introduction

Acquired pulmonary artery stenosis is a rare entity that has scarcely been described in the literature, and it is mainly associated with compression of the pulmonary artery trunk and its branches by mediastinal tumors (teratomas and lymphomas). We report the case of a young patient with non-Hodgkin lymphoma in the anterior mediastinum that led to extrinsic compression and local luminal invasion of the pulmonary artery trunk, causing significant impact on the right heart chambers, with subsequent improvement after chemotherapy.

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Original Article

Monitoring Myocardial Metabolic Changes in Lymphoma Patients Undergoing Chemotherapy Using FDG PET/CT

Diego Rafael Freitas Berenguer et al. Gustavo Freitas Alves de Arruda Monica de Moraes Chaves Becker Mayara Lais Coelho Dourado … Roberto de Oliveira Buril Felipe Alves Mourato Paulo José de Almeida Filho Brivaldo Markman-Filho Simone Cristina Soares Brandão

Abstract

Background:

Cardiotoxicity is a serious adverse effect of chemotherapy, often identified only after irreversible myocardial damage has occurred. Positron emission tomography/computed tomography (PET/CT) using fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) allows for the evaluation of myocardial glucose metabolism and may help detect early metabolic changes related to chemotherapy.

Objective:

To assess changes in ¹⁸F-FDG standardized uptake values (SUVs) across different cardiac regions before and after chemotherapy in patients with lymphoma, and to identify which region exhibits the greatest increase.

Methods:

This retrospective cohort study included 62 lymphoma patients who underwent ¹⁸F-FDG PET/CT before and after chemotherapy. SUV measurements were obtained in the left ventricular (LV) free wall, interventricular septum (IVS), right ventricular (RV) free wall, and global myocardium. Control regions included the liver and aorta. Pre- and post-treatment SUV values were compared to evaluate metabolic changes related to chemotherapy.

Results:

Myocardial ¹⁸F-FDG uptake increased significantly after chemotherapy across all cardiac regions, with the most pronounced rise observed in the LV free wall (maximum SUV increase of 73%, p<0.001). The RV free wall showed a non-significant increase in SUV, and no significant changes were observed in the liver or aorta.

Conclusions:

Chemotherapy was associated with a global increase in myocardial ¹⁸F-FDG uptake, with the most pronounced elevation observed in the LV free wall. This regional predominance highlights the LV free wall as the most sensitive site for detecting early metabolic changes potentially related to cardiotoxicity.

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Case Report

Cardiac Lymphoma: A Case Report

Leticia Ferraz Pamplona et al. Kelly Barnabé Serpa de Oliveira João Ancelmo dos Reis Neto Luis Antelo Bustamante … Januário Manoel de Souza Flávia Fernandes Silva Zacchi Juliana Brenande de Oliveira Brito Salomon Soriano Ordinola Rojas

Abstract

Cardiac tumors are rare. Primary cardiac lymphoma is defined as non-Hodgkin lymphoma that involves only the heart and/or pericardium. It is an aggressive tumor with a poor prognosis and its symptoms may be nonspecific. A definitive diagnosis can only be obtained through histopathological study, and chemotherapy is the main treatment strategy.

This case is about a 71-year-old male patient, with a rare form of primary cardiac tumor. He had postoperative complications such as acute pulmonary edema and the need for a pacemaker, which occurred after tumor resection requiring reconstruction of the vena cava and suture of the right atrium.

Primary cardiac lymphoma is a tumor that is difficult to diagnose because it has a vague and non-specific symptomatic presentation. However, it should always be included as a differential diagnosis of cardiac masses. Early diagnosis can significantly improve the prognosis and increase the survival rate of patients by quickly referring them for specific treatment.

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Research Letter

Progression of Myocardial 18F-FDG Uptake in a Patient with Cardiotoxicity

Diego Rafael Freitas Berenguer et al. Monica de Moraes Chaves Becker Roberto de Oliveira Buril Paula Araruna Bertão … Brivaldo Markman Filho Simone Cristina Soares Brandão

Abstract

The objective of this case report was to present the progression of chemotherapy-induced cardiotoxicity in a patient with lymphoma, highlighting the importance of myocardial fluor-18-fluorodeoxyglucose (18F-FDG) uptake by positron emission tomography coupled with computed tomography (PET/CT).

43-year-old female patient with uterine lymphoma, who underwent hysterectomy followed by three chemotherapy regimens and radiotherapy. The patient had episodes of acute heart failure two years after chemotherapy. Echocardiogram revealed a reduction in left ventricular ejection fraction (LVEF). A retrospective analysis of ¹⁸F-FDG PET/CT showed an increase in myocardial uptake in all tests performed during oncologic treatment.

Despite disease remission, the patient developed heart failure with reduced LVEF. During chemotherapy, there was a diffuse, significant increase in myocardial ¹⁸F-FDG uptake, which preceded the decrease in myocardial performance and seemed to reflect metabolic changes in cardiomyocytes, related to cardiotoxicity. Would an analysis of myocardial ¹⁸F-FDG uptake yield a different cardiac outcome in this patient? This question is relevant, considering that other patients may benefit from the use of PET as an early marker of cardiotoxicity.

Imaging tests are essential in the follow-up of patients at risk of cardiotoxicity. Although echocardiography remains the main imaging test in the diagnosis of cardiotoxicity, 18F-FDG PET/CT may be a powerful tool for the early diagnosis of this condition.

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Case Report

Primary Cardiac Lymphoma: Role of Imaging Multimodality in Diagnosis

Julia Werneck Paulino Soares de Souza et al. Luiza Telles de Andrade Alvares Maria Paula Righeti Gonçalves Ana Beatriz Aisemann Goulart Paiva … Ricardo Lopes Ferreira Marcelo Goulart Paiva

Abstract

Intracardiac masses are a diagnostic challenge since their symptoms can be common to cardiovascular pathologies. Some methods, whether invasive or not, enable differential diagnosis, histological confirmation, and adequate treatment. To better understand the importance of imaging multimodality and the approach to managing cardiac tumors, we investigated a case of a primary cardiac lymphoma in which the multidisciplinary approach allowed rapid diagnosis and treatment, including of intercurrences, with a promising initial response despite fatal progression due to severe acute respiratory syndrome coronavirus 2 infection.

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Original Article

Chemotherapy-induced Cardiac18F-FDG Uptake in Patients with Lymphoma: An Early Metabolic Index of Cardiotoxicity?

Mayara L. C. Dourado et al. Luca T. Dompieri Glauber M. Leitão Felipe A. Mourato … Renata G. G. Santos Paulo J Almeida Filho Brivaldo Markman Filho Marcelo D. T. Melo Simone C. S. Brandão

Abstract

Background

It is uncertain whether myocardial fluorodeoxyglucose uptake occurs solely due to physiological features or if it represents a metabolic disarrangement under chemotherapy.

Objective

To investigate the chemotherapy effects on the heart of patients with lymphoma by positron emission tomography associated with computed tomography scans (PET/CT) with 2-deoxy-2[18F] fluoro-D-glucose (¹⁸F-FDG PET/CT) before, during and/or after chemotherapy.

Methods

Seventy patients with lymphoma submitted to¹⁸F-FDG PET/CT were retrospectively analyzed. The level of significance was 5%.¹⁸F-FDG cardiac uptake was assessed by three measurements: left ventricular maximum standardized uptake value (SUVmax), heart to blood pool (aorta) ratio, and heart to liver ratio in all the exams. Body weight, fasting blood sugar, post-injection time, and the injected dose of¹⁸F-FDG between the scans were also compared.

Results

Mean age was 50.4 ± 20.1 years and 50% was female. The analysis was carried out in two groups: baseline vs. interim PET/CT, and baseline vs. post-therapy PET/CT. There was no significant difference in clinical variables or protocol scans variables. We observed an increase in left ventricular (LV) SUVmax from 3.5±1.9 (baseline) to 5.6±4.0 (interim), p=0.01, and from 4.0±2.2 (baseline) to 6.1±4.2 (post-therapy), p<0.001. A percentage increase ≥30% of LV SUVmax occurred in more than half of the sample. The rise of cardiac SUV was accompanied by an increase in LV SUVmax/Aorta SUVmax and LV SUVmean/Liver SUVmean ratios.

Conclusion

This study showed a clear increase in cardiac¹⁸F-FDG uptake in patients with lymphoma during and/or after chemotherapy. The literature corroborates with these findings and suggests that¹⁸F-FDG PET/CT is a sensitive and reliable imaging exam to detect early metabolic signs of cardiotoxicity.

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Large Lymphoma Involving the Aortic Arch and its Branches: Demonstration by Echocardiography and Contribution to the Assessment of Hemodynamic Repercussions

Israel Nilton de Almeida Feitosa et al. Maísa Carneiro Wanderley

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Cardiac Lymphoma: A Rare Cause of Acute Heart Failure with Restrictive Physiology

Fernando Garagoli et al. Ezequiel Guzzetti Ezequiel Lillo Luciano Lucas César Belziti

A 74-year-old woman with a history of membranous glomerulonephritis and a recent diagnosis of mediastinal adenopathy was admitted to the emergency department with acute heart failure. She complained of progressive dyspnea and weakness in the last week. Physical examination revealed hypotension, tachypnea, jugular vein distention, and desaturation. The most relevant laboratory findings were: anemia, lymphocytopenia, lactic acidosis, and increased lactate dehydrogenase. An electrocardiogram showed rapid atrial fibrillation and low-voltage QRS complexes. An echocardiogram revealed severe pericardial effusion and diffuse heterogeneous thickening of the ventricular and atrial walls. The patient required mechanical ventilation and inotropic support. Therapeutic pericardiocentesis was performed without clinical improvement. Cardiovascular magnetic resonance imaging (CMR) showed septal bounce (compatible with restrictive physiology) and a heterogeneous isointense mass surrounding the ventricular and atrial walls with late gadolinium enhancement of the myocardium and hypoenhancement of the tumor (), compatible with primary cardiac lymphoma. A diagnosis of large B-cell lymphoma was confirmed by flow cytometry of the pericardial fluid. The patient died before starting chemotherapic treatment.

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Case Report

Transient lymphadenopathy secondary to nephrotic syndrome

Olívia Meira Dias et al. André Nathan Costa Carlos Roberto Ribeiro Carvalho Ronaldo Adib Kairalla

Mediastinal lymphadenomegaly secondary to hypervolemia is an underdiagnosed tomographic finding. Herein we describe, in a patient with normal cardiac function, findings of pulmonary congestion associated to lymph node enlargement. The nephrotic syndrome causing hypoalbuminemia, low plasma colloid osmotic pressure and augmented transcapillary fluid leakage was the probable cause of the radiological findings.

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