Severe Right Ventricular Outflow Tract Obstruction Caused by Non-Hodgkin Lymphoma: Complete Regression after One Course of Bendamustine/Rituximab Therapy

• Published in: Journal of the American Society of Echocardiography Vol. 24; no. 7; pp. 818.e1 - 818.e4
• Main Authors: Konstandin, Mathias H., MD, Korosoglou, Grigorios, MD, Hosch, Waldemar, MD, Hardt, Stefan E., MD, Katus, Hugo A., MD, Mereles, Derliz, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2011
• Subjects: Aged; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - therapeutic use; B-cell non-Hodgkin lymphoma; Bendamustine and rituximab; Bendamustine Hydrochloride; Cardiovascular; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography; Female; Follow-Up Studies; Humans; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - diagnosis; Lymphoma, B-Cell - drug therapy; Nitrogen Mustard Compounds - therapeutic use; Recovery of Function - physiology; Right ventricular outflow tract obstruction; Rituximab; Severity of Illness Index; Tomography, X-Ray Computed; Ventricular Function, Right - physiology; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - etiology; B-cell non-Hodgkin lymphoma; Echocardiography; Bendamustine and rituximab; Right ventricular outflow tract obstruction
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2010.09.005

We present the case of a 67-year-old woman presenting with symptoms of predominantly right heart failure caused by cardiac tumor infiltration. Echocardiography showed almost complete obstruction, particularly of the right ventricular outflow tract. After complete diagnostic workup, treatment with only one course of bendamustine and rituximab resulted in complete resolution of the obstruction. Right ventricular outflow tract restriction due to infiltrative large B-cell lymphoma is a rare finding. Compression of the heart and great vessels, such as by mediastinal tumors, is not as rare. Prompt and accurate diagnosis by echocardiography and immediate initiation of treatment can be lifesaving.