CHEST Guidelines-A-78-Year-Old-Man-With-Diffuse-Lymphadenopathy,-a-

A-78-Year-Old-Man-With-Diffuse-Lymphadenopathy,-a-

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This case study discusses a 78-year-old man with a history of several health conditions, including COPD, prostate cancer, coronary artery disease, and atrial fibrillation. He was admitted to the hospital with symptoms of dry cough, weakness, shortness of breath, and significant unintentional weight loss. Examination revealed diffuse lymphadenopathy and a left pleural effusion. Biopsy identified diffuse large B-cell lymphoma (DLBCL).<br /><br />During hospitalization, the patient's shortness of breath worsened, prompting additional ultrasonography by the pulmonary service. The ultrasound findings revealed a moderate-sized pleural effusion with septations and a significant mass within the pleural space, indicative of a malignant effusion likely related to pleural lymphoma.<br /><br />The ultrasound also detected a previously unknown cardiac mass adherent to the right ventricle and pericardial effusion, suggesting cardiac lymphoma involvement, which is not uncommon in non-Hodgkin lymphoma but was unrecognized in this patient prior to the imaging. The examination ruled out cardiac tamponade since typical signs such as RV collapse were absent, attributing this to the mass's effect on RV wall compliance. <br /><br />These findings led to the diagnosis of stage IV DLBCL with pleural and cardiac involvement. Treatment with chemotherapy resulted in complete resolution of the pleural and cardiac masses.<br /><br />The study underscores the value of point-of-care ultrasonography (POCUS) in diagnosing and characterizing pleural effusions and its utility in identifying unexpected cardiac involvement in patients with malignancies, thereby enhancing patient care without invasive procedures. The case illustrates POCUS's ability to detect additional complications and refines clinical decision-making in complex oncological presentations.

Keywords

DLBCL

pleural effusion

cardiac involvement

point-of-care ultrasonography

non-Hodgkin lymphoma

malignant effusion

cardiac mass

chemotherapy

oncological diagnosis

patient care