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Cardiovascular Images
June 19, 2019

An Elderly Man With Periorbital Swelling and Sinus Congestion

Author Affiliations
  • 1Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Cardiol. 2019;4(9):947. doi:10.1001/jamacardio.2019.1865

A previously healthy elderly man presented with facial plethora, periorbital swelling, and sinus congestion. After multiple visits, a computed tomographic scan of his chest was performed and revealed clinical superior vena cava syndrome owing to a right atrial mass. Cardiac magnetic resonance imaging demonstrated a large (9.0 × 8.5 cm), irregularly shaped, centrally enhancing mass occupying most of the right atrium with complete encasement and moderate to severe narrowing of the lower superior vena cava. There was no invasion of adjacent structures. He underwent right heart catheterization with a biopsy. Pathologic testing revealed diffuse large B-cell lymphoma. A positron emission tomographic/computed tomographic scan did not uncover a primary extracardiac source of lymphoma. He was thus diagnosed with primary cardiac lymphoma (Figure).