The “Broad Beans in Pod Sign” of echocardiography for myocardial infiltration of diffuse large B-cell lymphoma

Excerpt

A 68-year-old male was admitted for worsening dyspnea due to heart failure. He was diagnosed with diffuse large B-cell lymphoma (DLBL) without cardiac involvement 2 years ago and treated with chemotherapy. Although complete response was obtained after initial chemotherapy, the recurrence and progression of DLBL were observed after 6 months of complete response. He received the maintenance chemotherapy with another regimen drugs. Echocardiography showed left ventricle (LV) systolic dysfunction with ejection fraction of 34%. There was small amount of pericardial effusion in inferolateral and right ventricular (RV) free wall (Fig. 1a). Heterogenous tissue material was noted in pericardial space and encased coronary sinus in atrioventricular (AV) groove. Well-delineated, hypoechoic densities were observed in inferolateral wall and RV free wall. In apical 4-chamber view, multiple nodular hypoechoic densities were demonstrated in anterolateral wall (Fig. 1b). These hypoechoic nodules were also observed in mid-inferior/inferolateral/anterior wall in parasternal short axis view (Fig. 1c). There was adhesion of RV free wall, its pericardial space, and thoracic wall. Furthermore, the hypoechoic density was noted in RV inferior and anterior wall of apical level along with pericardial effusion (Fig. 1d). However, the patient eventually expired, even though he underwent and maintained chemotherapy.

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