Poster Session:PS 0573 ; Oncology : Cardiac Lymphoma: Case Report

저작시기 2014.01 |등록일 2015.01.05 | 최종수정일 2015.04.23 파일확장자어도비 PDF (pdf) | 1페이지 | 가격 1,000원
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발행기관 : 대한내과학회 수록지정보 : 대한내과학회 추계학술발표논문집 / 2014권 / 1호
저자명 : ( Valentin Kokorin )

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Patient, 34 y.o. male, was admitted with complaints of fever (up to 39°C for 1 month) and dyspnea at night time. On ECG ST-segment elevation in inferior leads and ST-segment depression in V1-V3 was revealed. The patient was hospitalized to the intensive care unit with suspected STEMI. Condition at admission was moderate. HR 85/min, rhythm regular, BP 110/70 mm Hg. On echo: LV hypertrophy (2 cm), hypokinesis of inferior LV wall, ejection fraction 30% and pericardial effusion (0,8-2 cm). In lab tests: Hb 114 g/l, platelets 151x109/l, WBC 2.3x109/l, CK-MB 41 U/l, troponin T 321 ng/l, CRP 17 mg/l. On the next day the level of troponin T was 800 ng/l, D-dimer 705 ng/ml. On coronary angiography no abnormalities revealed. Differential diagnosis between myocardial infarction, pulmonary embolism, miocarditis and sepsis was performed. Patient was treated with anticoagulants, antiaggregants, ß-blockers, ACE inhibitors, statins, diuretics, antibiotics and anti-infi ammatory drugs. In serologic test mild elevation of IgM antibodies to Chlamidia trachomatis and cytomegalovirus was revealed. Blood culture and procalcitonin test was negative. On echo low LV EF and moderate pericardial effusion remained. In a week after admission the level of Hb was 94 g/l, creatinine 260 mcmol/l, hypoalbuminemia 28 g/l, CRP 212 mg/l, BNP 24809 pg/ml. Despite ongoing treatment patients` status progressively worsened, hyperthermia remained, dyspnea at rest, arterial hypotension, oliguria and fi nally cardiogenic shock developed. The patient died on day 12 after admission. On autopsy heart weight 480 g, on epicardium and endocardium grained whitish spots on a dark Background: Myocardium with multiple well-demarcated areas of whitish color. Microscopy: lymphocytic infi ltration and necrosis areas. Similar lesions in anterior mediastinum, thyroid gland, small intestine. final diagnosis: diffuse B-cell lymphoma with extranodal dominantly cardiac lesions. This case demonstrates diversity clinical picture of cardiac lymphoma and complexity of its diagnosis and treatment.

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