MRI에서 비허혈성 심근병증으로 오인된 좌심실의 림프종: 증례 보고

Non-mass-forming Lymphoma of the Left Ventricle Mimicking Non-ischemic Cardiomyopathy on MR Imaging: A Case Report

  • 신원선 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 김성목 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 최연현 (성균관대학교 의과대학 삼성서울병원 영상의학과) ;
  • 현지연 (성균관대학교 의과대학 삼성서울병원 병리과) ;
  • 김정선 (성균관대학교 의과대학 삼성서울병원 병리과) ;
  • 장성아 (성균관대학교 의과대학 삼성서울병원 순환기내과)
  • Shin, Won-Seon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Sung-Mok (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choe, Yeon-Hyeon (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hyeon, Ji-Yeon (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jung-Sun (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Sung-A (Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2012.08.14
  • 심사 : 2012.08.27
  • 발행 : 2012.08.31

초록

40세 남성에서 상대정맥의 폐쇄와 우폐동맥 협착을 동반한 종격동 종괴가 발견되어 병리학적 소견에 경화성 종격동염으로 진단되었고, 6개월 후 심장 자기공명영상(MRI)에서 비허혈성 심근병증으로 의심된 심장림프종의 예를 보고하고자 한다. 심장 초음파에서 제한적 양상의 심장 생리현상을 보였고 구혈율이 매우 감소되어 있었다. MRI에서 전반적인 심근비대와 조영제 주입 후 광범위한 지연조영증강이 있어 비허혈성 심근병증이 의심되었으며 심장근육 생검 후 림프종으로 확진되었다. 조영제 주입후 MRI에서 심근 기저부는 침범되지 않았고 전반적인 심내막 보존이 있었으므로 아밀로이드증과 구별되는 양상이고 종괴를 형성하지 않았기 때문에 심장종양 보다는 심근병증에 더 유사한 영상 소견을 보인 특이한 증례로서 심장림프종의 자기공명영상에서의 특징을 문헌고찰과 함께 보고하고자 한다.

We report a case of cardiac lymphoma in a 40-year-old man, who had a mediastinal mass which was diagnosed as sclerosing mediastinitis pathologically. The mediastinal mass caused right pulmonary arterial stenosis. The patient developed myocardial hypertrophy and echocardiography showed restrictive physiology and severely decreased left ventricle ejection fraction, 6 months later. MRI showed global left ventricular myocardial hypertrophy and diffuse late gadolinium hyperenhancement after administration of contrast material. Thus, non-ischemic cardiomyopathy was suspected on MRI. However, pathology confirmed the myocardial abnormality as lymphoma after myocardial biopsy. Because a basal part of the left ventricle and global subendocardial myocardium were not involved on contrast-enhanced delayed MRI, the MRI abnormalities could be differentiated from amyloidosis and other myocardial diseases. The peculiar non-mass forming diffuse hypertrophy pattern of cardiac lymphoma has not been known in the MRI literature.

키워드

참고문헌

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