About the Cover
ON THE COVER A 4-year-old child presented with fever of 2 months duration. He had tachycardia, tachypnea, pallor, cervical lymphadenopathy, and hepatoslenomegaly. An echocardiogram showed a well circumscribed 47 × 35 mm mass arising from the right ventricle, extending into and partially obstructing the outflow tract and pericardial effusion (panels A and B). A computed tomography scan showed metastatic lesions in lungs and kidneys with para-aortic lymph nodes in addition. Open lung biopsy confirmed the diagnosis to be anaplastic large cell Non Hodgkin's lymphoma. A repeat echocardiogram after 5 weeks of chemotherapy showed complete disappearance of the tumor and effusion (panels C and D). The tumor has been in remission for the last 2.5 years. Malignant cardiac tumors are rare (1). Secondary lymphomas are relatively common but often undetected before death (2). In the present era, echocardiography helps in both diagnosis and also follow up of cardiac tumors (3). Interestingly, in this case the intra-cardiac mass by trans-thoracic echocardiography was not only a clue to the diagnosis of lymphoma but also helped to follow up the course, where it vanished completely following chemotherapy and remained in remission for 2.5 years. Image provided by Purendra Kumar Pati, MD, DM, V. Jacob Jose, MD, DM, FICC, FACC, Paul V. George, MD, DM, from the Department of Cardiology, Christian Medical College and Hospital, MGR University, Vellore, India
REFERENCES
1. McAllister HA Jr., Fenoglio JJ Jr. Atlas of Tumor Pathology: Tumors of the Cardiovascular System. 2nd Series, Fascicle 15. Washington, DC: Armed Forces Institute of Pathology, 1978.
2. Roberts WC, Glancy DL, De Vita VT Jr. Heart in malignant lymphoma (Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma and mycosis fungoides): a study of 196 autopsy cases. Am J Cardiol 1968;22:85–107.
3. Timperley J, Mitchell ARJ, Becher H. Primary cardiac lymphoma. Eur J Echocardiography 2003;4:327–30.
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Copyright © 2008 by the American College of Cardiology Foundation.
