CTICasesPericardial Anaplastic Large Cell Lymphoma
Imaging findings
Cardiac MR demonstrates marked, irregular, highly nodular pericardial thickening accompanied by a pericardial effusion and bilateral pleural effusions. Real-time perfusion imaging highlights prompt first-pass perfusion of the nodular soft tissue components, and delayed enhancement imaging confirms extensive hyperenhancement. Despite the severe pericardial thickening, there is a lack of classic structural findings of constrictive pericarditis, such as tubular ventricles or biatrial enlargement, and only mild respiratory interventricular septal bounce is noted. Accompanying mediastinal lymphadenopathy is present.
Key takeaways
Markedly thickened, nodular pericardium with rapid first-pass perfusion and intense delayed enhancement on cardiac MRI suggests neoplastic involvement of the pericardium rather than benign fibrous constriction. Pericardial lymphoma, such as anaplastic large cell lymphoma, can present with extensive nodular soft tissue thickening and effusion, mimicking constrictive physiology but retaining relatively normal cardiac chamber morphology.
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