Perry Fisher
Mount Sinai Beth Israel Medical Center, USA
Title: The use of contrast echocardiography to identify infiltrating lymphoma in the myocardium
Biography
Biography: Perry Fisher
Abstract
Angioimmunoblastic T-Cell Lymphoma (AITL) is an uncommon lymphoma with rare cardiac manifestations. We present a clinical example where non-contrast and contrast enhanced echocardiograms demonstrated remarkably different myocardial compositions, particularly in our patient identifying infiltrating lymphoma in the myocardium. Case: A 68-year-old African American man with past medical history of AITL presented with weakness and fatigue for 2 weeks. Transthoracic echocardiogram (TTE) without contrast was performed that showed a pericardial effusion and an echolucency of the left ventricle concerning for pseudoaneurysm. Repeat TTE was performed using IV contrast revealed the presence of multiple non-communicating hypodensities within the myocardium. Pericardial fluid analysis did not reveal evidence of lymphoma, however pleural fluid cytology exhibited abnormal cells consistent with T-cell lymphoma. Discussion: In our patient, contrast enhanced echocardiography identified infiltrating lymphoma in the myocardium that was not seen with standard 2D imaging. Echocardiographic contrast agents are excellent tools for the evaluation of the LV endocardium especially in the detection and classification of intracardiac masses, including thrombi and tumors. Most malignant tumors, secondary to neovascularization, have an abnormally concentrated and dilated vasculature and concordantly, will display increased contrast enhancement compared to the adjacent myocardium. Contrary to the norm, we found metastatic lesions in our patient with deceased pixel intensity. The use of contrast agents should be considered when evaluating patients with non-cardiac diseases that have the potential for infiltrating the myocardium, but the level of contrast enhancement may be variable with certain types of tumors.: Angioimmunoblastic T-Cell Lymphoma (AITL) is an uncommon lymphoma with rare cardiac manifestations. We present a clinical example where non-contrast and contrast enhanced echocardiograms demonstrated remarkably different myocardial compositions, particularly in our patient identifying infiltrating lymphoma in the myocardium.