# Primary Cardiac Lymphoma Presenting as a Right Ventricular Mass With Outflow Obstruction: A Diagnostic-Therapeutic Challenge

## TL;DR

An elderly woman with a rare heart tumor was diagnosed and treated with a combination of steroids and chemotherapy, highlighting the importance of early detection and coordinated care.

## Contribution

This case emphasizes the importance of multimodality imaging and multidisciplinary care in diagnosing and treating rare primary cardiac lymphoma in elderly patients.

## Key findings

- Echocardiography and computed tomography confirmed a right ventricular mass causing heart failure.
- Biopsy identified CD20+ B-cell lymphoma, leading to treatment with corticosteroids and R-CHOP chemotherapy.
- Prompt diagnosis and coordinated care are crucial for improving outcomes in primary cardiac lymphoma.

## Abstract

Primary cardiac lymphoma (PCL) is an exceedingly rare malignant non-Hodgkin lymphoma. It represents <2% of primary cardiac tumors often with nonspecific symptoms that may delay diagnosis.

An 83-year-old woman with hypertension and hypothyroidism presented with progressive dyspnea and fatigue. The initial differential diagnosis was concerning for pulmonary embolism or right-heart failure. Echocardiography revealed a 6 × 7-cm right ventricular mass causing right ventricular outflow tract obstruction and right-sided heart failure. Computed tomography confirmed the presence of a mass, and biopsy identified CD20+ B-cell lymphoma. After a multidisciplinary discussion, she was started on high-dose corticosteroids with subsequent chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone).

This case highlights the diagnostic challenge of PCL in the elderly and underscores the necessity of early multimodality imaging and coordinated care. A review of the literature shows that prompt recognition and treatment are essential for improving outcomes in this rare malignancy.

Early diagnosis via comprehensive imaging and biopsy along with a multidisciplinary approach for management are all crucial steps in early detection and treatment of PCL, particularly in elderly patients.