A case of Primary Mediastinal large B cell Lymphoma Presenting as Constrictive Pericarditis and in remission after chemotherapy
Authors: Fu Yuwei , Cai Liehuo , Zhu Xinyan , Ren Yubo , Wen Chaoyang 
Published: January 2023

INTRODUCTION A 54-year-old female patient was transferred to
our hospital because of progressive aggravation of chest tightness and
suffocation for more than 1 month. ECG suggested an incomplete right
bundle branch block. Cardiac ultrasound showed that the pericardial
visceral layer was thickened unevenly and the echo was enhanced. The
thickness of left ventricular apex was about 12mm, the left ventricular
lateral wall was about 10mm, and the right ventricular lateral wall was
about 11mm (Figure [1](#fig-cap-0001)). The pericardial visceral
layer and the wall layer at the left ventricular lateral wall and the
lateral posterior wall adhered to each other, resulting in reduced
myocardial motion and the angle between left atrium and left ventricular
posterior wall became smaller (Movie 1-2). Massive amount of
hydropericardium can be seen in the pericardial cavity. The liquid depth
of the right atrium is 20mm, the liquid depth of the right ventricular
side wall is 22mm, and the band-like cellulose exudation can be seen
between the right ventricular side wall and the pericardium (Movies 3).
Tissue Doppler showed that the velocity e ‘of the mitral annulus on the
ventricular septal side was 8.1cm/s, and the velocity e’ of the mitral
annulus on the left ventricular lateral wall side was 3.5cm/s (Figure
[2](#fig-cap-0002)-3). At the same time, a hypoechoic mass in the
anterior mediastinum surrounding the ascending aorta and pulmonary
artery can be scanned. Color Doppler flow imaging indicates that there
is no blood flow signal inside the mass (Figure
[4](#fig-cap-0003)-5). It is considered as a solid space occupying
lesion in the mediastinum, with the exception of constrictive
pericarditis caused by lymphoma pericardial infiltration, pericardial
effusion (large amount), partial reduction of left ventricular wall
motion and left ventricular diastolic function. PET-CT showed that there
were irregular lumpy and flaky soft tissue density foci in the middle
and upper mediastinum, which locally surrounded the blood vessels and
trachea; The pericardium is unevenly thickened, the glucose metabolism
is significantly increased (SUVmax 25.0), and the pericardium can see
fluid density lesions. It is considered that this is the involvement of
lymphoma as well (Figure [6](#fig-cap-0004)). Ultrasound in the
neck suggested that the right supraclavicular lymph node was enlarged,
and a lymph node puncture was performed to eventually diagnose primary
mediastinal large B cell lymphoma (Figure 7-8). After one cycle of
treatment with the first-line RCHOP regimen (metoclopramide 600mg D1,
cyclophosphamide 1.16g D2, vincristine 2mg D2, pirarubicin 77mg D2,
prednisone 100mg d2-6, q21d), the reexamination of cardiac ultrasound
showed that the thickening of the pericardial viscera was less than
before, the left ventricular wall motion of the lateral and posterior
wall recovered significantly (Movie 4-5). Tissue Doppler showed that the
velocity e ‘of the mitral annulus on the ventricular septal side was
7.8cm/s, the velocity e’ of the mitral annulus on the left ventricular
side wall was 6.6cm/s(Figure [9](#fig-cap-0006)-10), and the
pericardial effusion disappeared(Figure [11](#fig-cap-0007)).