Recommended Citation
Fletcher N, Bonaguro AM, Li Y. Echoes of malignancy: Triple-hit lymphoma presenting as an isolated pericardial effusion. Poster presentation at: ACMC Research Day 2026; April 29, 2026; Oak Lawn, IL.
Presentation Notes
Poster presentation at: ACMC Research Day 2026; April 29, 2026; Oak Lawn, IL.
Abstract
Background: Malignancy is the second most common cause of pericardial effusion, typically occurring in advanced stages. Lymphomas account for a minority of malignant effusions, with symptomatic pericardial disease as their initial presentation being exceptionally rare. Case: A 64-year-old man with chronic obstructive pulmonary disease presented with two weeks of progressive dyspnea, orthopnea, and productive cough. Chest radiograph showed an enlarged cardiac silhouette and bibasilar opacities. Computed tomography of the chest revealed a complex circumferential pericardial effusion up to 3.6 cm, confirmed on transthoracic echocardiography (TTE) with diastolic underfilling but no tamponade physiology. Pericardiocentesis yielded 660 mL of sanguineous fluid (glucose 51 mg/dL, LDH >1,000 U/L, total protein 6.7 g/dL) and atypical large lymphocytes observed on smear. Cultures showed no growth after 5 days of incubation, repeat TTE showed no reaccumulation, and the patient was discharged on hospital day 7. Flow cytometry and fluorescence in situ hybridization, finalized after discharge, identified abnormal B-cells consistent with High-grade B-cell lymphoma with MYC, BCL2, and BCL6 rearrangements (triple hit lymphoma). Decision Making: Initial presentation and evaluation were suggestive of new congestive heart failure. Imaging obtained for refractory hypoxemic respiratory failure identified a large complex effusion prompting pericardiocentesis. Hemorrhagic fluid and cytology raised suspicion for malignancy despite no known oncologic history or constitutional symptoms. The patient was discharged only following an unrevealing infectious workup and obtaining clinical stability. Subsequent imaging for staging revealed an uncommon pattern of an isolated hypermetabolic thick pericardial effusion without other abnormal uptake. Conclusion: Acute heart failure symptoms without an established diagnosis warrant evaluation for alternative etiologies beyond empiric management. A symptomatic pericardial effusion may represent the initial manifestation of high-grade triple-hit lymphoma, even in the absence of hypermetabolic lymphadenopathy.
Type
Poster