https://orcid.org/0000-0001-8037-8000
A 76-year-old man presented with 1 month history of dyspnoea and bilateral leg swelling. Examination revealed moderate pitting peripheral oedema and a systolic murmur. The electrocardiogram showed sinus rhythm with right bundle branch block, and T wave inversions in V1–V3. Both troponin-T (50 ng/L) and N Terminal Brain Natriuretic Peptide (8431 ng/L) were elevated. A transthoracic echocardiogram showed a mass occupying the apical third of the right ventricle (RV) (Panel A, *) with surrounding small pericardial effusion (Panel A, arrow).
To characterize the RV mass, contrast enhanced images were obtained. Immediately after administration, there was opacification of the RV cavity with no perfusion of the mass (Panel B). After 10–20 s, there was widespread, homogenous uptake of microbubble within the RV mass (Panel C). This confirmed the perfusion of the mass and therefore the most likely diagnosis of vascular malignant tumour rather than an avascular thrombus. The mass also protruded into the right ventricular outflow tract and pulmonary valve, causing obstruction (Vmax 3.42 m/s) (Panel D).
The patient underwent RV biopsy which revealed high grade B cell lymphoma. Positron emission tomography showed stage IV disease with nodal involvement above and below the diaphragm (Panel E) and a large area of intense uptake involving mainly the RV, interventricular septum, the LV apex, and part of basal left lateral wall (Panel F). Subsequently, he was considered for chemotherapy but had poor functional status and was palliated. This case demonstrates the utility of contrast enhanced ultrasound for assessment of vascularity of cardiac masses to help identify aetiology.
Data availability
No new data were generated or analysed in support of this research.
Author notes
Conflict of interest: None declared.
