Lymphoma with cardiac and renal involvement: Report of a case imaged by CT with cinematic rendering

Abstract

Myocardial lymphoma can be seen in the setting of primary or secondary involvement, more common in later. Both primary and secondary involvement is usually seen in the setting of diffuse large B cell lymphoma. We describe a case of a 47-year-old man in cardiogenic shock due to refractory ventricular tachycardia (VT) necessitating intubation, extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump with diffuse thickening of the left ventricular myocardium on CTA chest and subtle infiltrative ill-defined perirenal hypodensities with renal enlargement on CT of abdomen and pelvis. Post-processing with cinematic rendering clearly showed improved tissue contrast and/or differentiation with better demarcation of both the myocardial and renal lesions. A myocardial biopsy demonstrated diffuse large B-cell lymphoma (DLBCL). The patient was treated for ventricular tachyarrhythmias, cardiogenic shock, DCBCL, and numerous complications during 6-month long hospitalization with significant improvement of systolic function at discharge. Myocardial lymphoma is an uncommon cardiac malignancy with common CT imaging appearances of multiple circumscribed iso-attenuating masses or diffuse ill-defined infiltrative myocardial thickening. These findings are better assessed with cinematic rendering due to accentuated depth perception and photorealistic appearance of this post processing modality.

Keywords

• Diffuse large B-cell lymphoma (DLBCL)
• Extracorporeal membrane oxygenation (ECMO)
• Cinematic rendering (CR)