When Lymphoma Reaches the Heart: A Narrative Review of Cardiac Tamponade Presentations.

BACKGROUND

Pericardial effusion frequently complicates the clinical course of patients with malignancy; however, progression to cardiac tamponade is uncommon and may be life-threatening. Lymphoma constitutes an important etiology, particularly diffuse large B-cell lymphoma (DLBCL), whereas T-cell variants are exceedingly rare.

CASE PRESENTATION: A 26-year-old Syrian male presented with dyspnea, fatigue, and B symptoms. Radiologic evaluation demonstrated massive pericardial and pleural effusions, extensive lymphadenopathy, skeletal deposits, and bilateral renal involvement. Laboratory findings revealed anemia, thrombocytopenia, and marked hepatic enzyme elevation. Emergency echocardiography-guided pericardiocentesis drained 1000 mL of hemorrhagic exudate containing immature lymphoid cells. PET-CT demonstrated disseminated disease, and flow cytometry of the pericardial fluid confirmed peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). Because of progressive hemodynamic deterioration, systemic chemotherapy was initiated immediately based on flow-cytometric results without awaiting final lymph-node histopathology. CHOEP therapy led to rapid and marked clinical improvement within 24 h and complete effusion resolution after the first cycle.

DISCUSSION: A literature search (2021-2025) identified 34 cases of lymphoma-associated cardiac tamponade, 94% of which were B-cell derived. Only two involved T-cell lymphoma, and none described concurrent renal infiltration. The present case is, to our knowledge, the first report of PTCL presenting simultaneously with pericardial tamponade and renal involvement and highlights the life-saving importance of prompt, flow-cytometry-guided chemotherapy initiation.

CONCLUSION

Peripheral T-cell lymphoma may rarely manifest with acute cardiac tamponade and multiorgan dissemination. Urgent drainage followed by early chemotherapy-sometimes initiated before histopathologic confirmation-can be lifesaving. Recognition of such patterns may aid timely diagnosis and improve outcomes.