Sað Ventriküle Ýnvaze Mediastinal Kitle

Lenfomalarýn kalp tutulumu nadirdir ve çoðunlukla otopsi çalýþmalarý ile ortaya konulur. Buna karþýn kalp tutulumunun son derece ciddi sonuçlarý vardýr. Lenfomalarýn kalp tutulumu retrograd lenfatik, hematojen ve doðrudan komþuluk yoluyla direkt invazyon þeklinde olur. Direkt invazyon en sýk görüleni ve en destrüktif bulgulara yol açanýdýr. Klinik bulgu ve belirtileri nonspesifiktir. Bu yüzden erken taný ve tedavi hayat kurtarýr. Olgumuz efor dispnesi ve akciðer grafisinde görülen kardiomegali nedeni ile uzun süre kardiyoloji polikliniðinde tetkik edilmiþ, ekokardiografik incelemede mediastinal kitleden þüphelenilmesi üzerine kliniðimize refere edilmiþtir. Çekilen toraksýn bilgisayarlý tomografik incelemesinde mediasteni dolduran, sað ventrikül duvarýna radyolojik olarak invazyon düþündüren kitle saptanan hastaya ayný gün göðüs hastalýklarý uzmaný tarafýndan toraks ultrasonografisi rehberliðinde trucut biyopsi yapýlmýþ, biyopsiden üç gün sonra lenfoma patolojik tanýsý ile beraber hasta tedavi için hematoloji polikliniðine yönlendirilmiþtir. Tedavinin üçüncü haftasýnda ise hastanýn tüm yakýnmalarý gerilemiþtir. Bu makale kalp tutulumu þüphesi olan olgularda multidisipliner yaklaþýmla hýzlý taný ve tedavinin önemine ve toraks ultrasonografi ile mediastinal kitle lezyona hýzlý ve güvenli yapýlabilen biyopsi iþlemine dikkat çekmek için sunulmuþtur.

Mediastinal Mass Invading the Right Ventricle

Lymphoma with cardiac involvement is rare; however, there can be very serious consequences. It is usually revealed in autopsy studies. Cardiac invasion by lymphoma may occur through retrograde lymphatic flow, hematogenous spread, or direct invasion from neighboring structures. Direct invasion is the most common, and has the most destructive results. The clinical signs and symptoms are nonspecific. Presently described is the case of a patient who was initially examined in a cardiology polyclinic due to exertional dyspnea and cardiomegaly seen in a chest X-ray. Echocardiographic examination revealed a suspected mass and the patient was referred to our clinic. A mass lesion filling the mediastinum and invading the right ventricle was detected in a computed tomography image of the chest. On the same day, a tru-cut biopsy with thoracic ultrasound guidance was performed by the pulmonologist. Three days after the biopsy, the patient was referred to the hematology clinic for treatment of pathological lymphoma. This case was presented to draw attention to the importance of prompt diagnosis and treatment of thoracic and mediastinal mass lesions with a multidisciplinary approach and to emphasize that a biopsy can be performed quickly and safely in patients with a mediastinal mass with the guidance of ultrasound, even when there is cardiac involvement.