Massive pericardial effusion as the primary manifestation of high-grade malignant lymphoma

Pericardial effusion might be the first presentation of various pathologies including malignant tumors. Massive pericardial effusion as the primary manifestation of high-grade malignant lymphoma is a very rare condition. A 53-year-old woman presented with progressive dyspnea of one week history. Physical examination showed venous distention of the neck veins and diminished heart sounds. The chest X-ray demonstrated increased cardiothoracic index. Transthoracic and transesophageal echocardiographic examinations showed massive pericardial effusion without any other pathology. Hematologic and biochemical tests showed only anemia. The patient underwent pericardiocentesis. Pericardial adenosine deaminase test and cultures were negative. Cytopathologic examination of the fluid showed huge lymphocytes and highly atypical lymphoid cells consistent with high-grade malignant lymphoma (non-Hodgkin’s lymphoma). Immunohistochemical analysis showed positivity for leukocyte common antigen. No other primary origin could be determined.