BMJ Case Reports 2018; doi:10.1136/bcr-2018-225926
  • Unusual presentation of more common disease/injury

Pericardial effusion as first presentation of disseminated non-Hodgkin’s lymphoma

  1. Benjamin King1
  1. 1Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia
  1. Correspondence to Dr Lauren Christina Giudicatti, lauren.giudicatti{at}
  • Accepted 7 September 2018
  • Published 3 October 2018


A 46-year-old woman with quiescent lupus presented with worsening pleuritic chest pain and dyspnoea. Bedside echocardiogram confirmed large pericardial effusion with cardiac tamponade. Emergency bedside pericardiocentesis was performed. Pericardial fluid cytology confirmed diffuse large B cell lymphoma, stage four on positron emission tomography. Conventional rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy achieved good response in all sites except the pericardium. Progressive cardiac involvement was complicated by atrioventricular conduction block requiring permanent pacemaker. Second-line palliative chemotherapy was performed.


  • Contributors LG, MC and BK were involved in patient’s care. MC contributed significantly to authorship of the paper. BK contributed to authorship and final review of paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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