Po-05-126 a shocking turn of events: primary cardiac lymphoma as a rare cause for sudden cardiac death

Primary cardiac tumors are rare causes of ventricular arrythmias. This presentation of primary cardiac lymphoma highlights the importance of multimodality cardiac imaging for patients who suffer sudden cardiac arrest. N/A N/A A previously healthy 34 year-old woman suffered an out-of-hospital cardiac arrest. She received bystander CPR and multiple shocks in the field for VT and VF. ECG obtained on arrival showed salvos of monomorphic VT with a LBBB morphology as well as polymorphic VT. Post-arrest ECG demonstrated dynamic changes with evidence of a prolonged QT interval and Brugada type 1 pattern. After stabilization with metoprolol and intravenous lidocaine, cardiac MRI showed an infiltrating mass along the epicardial surface of the right ventricular outflow tract (RVOT). A cardiac CT was subsequently performed for surgical biopsy planning. Biopsy was obtained via hemi-sternotomy; tissue histopathology of the RVOT mass revealed diffuse large B-cell lymphoma. PET and CT scans indicated no evidence of metastatic disease. The patient was diagnosed with primary cardiac lymphoma, and underwent inpatient chemotherapy treatment. A subcutaneous ICD was implanted prior to discharge for secondary prevention. Key images are displayed in Figure 1. This case demonstrates a rare cause of sudden cardiac arrest in a young patient with a new diagnosis of primary cardiac lymphoma. Primary cardiac lymphoma is a very rare disease that accounts for less than 1% of all primary cardiac malignancies, and less than 0.5% of all extra nodal lymphomas. The use of multimodality imaging after a cardiac arrest in this case led to a timely diagnosis and rapid initiation of life saving treatments.