CTICasesCardiac (Myocardial) B-Cell Lymphoma Mimicking Hypertrophic Cardiomyopathy
Imaging findings
A patient with pulmonary nodules incidentally had mildly thickened myocardium on CT. Cardiac MRI showed diffuse myocardial thickening resembling hypertrophic cardiomyopathy, but T2 imaging lacked the abnormal signal expected with true HCM, and delayed imaging showed hazy mid-myocardial hyperenhancement. A same-day abdominal MRI in portal venous phase, not initially reviewed alongside the cardiac study, showed a large infiltrative hypodense myocardial mass that had not been present eight months earlier; a follow-up study a few months later showed multiple infiltrative cardiac masses extending into the pericardium, with growth of the pulmonary nodules, confirmed as B-cell lymphoma.
Key takeaways
Myocardial infiltration by lymphoma can closely mimic hypertrophic cardiomyopathy with wall thickening and delayed hyperenhancement, but lacks the T2 abnormalities of true HCM. The case also highlights the pitfall of same-day chest (arterial phase) and abdomen/pelvis (portal venous phase) studies being interpreted as unrelated separate examinations, which delayed recognition that the abdominal study had already shown a new infiltrative myocardial mass corresponding to the cardiac MRI findings.
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