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(Circulation. 2005;112:e322-e323.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Transient Giant Negative T Waves Associated With Cardiac Involvement of Diffuse Large B-Cell Lymphoma

Masahiro Ito, MD, PhD; Junjiro Tsuchiyama, MD, PhD; Masaomi Chinushi, MD, PhD; Makoto Kodama, MD, PhD; Yoshifusa Aizawa, MD, PhD

From the First Department of Internal Medicine, Niigata University Medical Hospital, Niigata, Japan.

Correspondence to Masahiro Ito, MD, PhD, First Department of Internal Medicine, Niigata University Medical Hospital, 1-754 Asahimachi, Niigata-City, 951-8510, Japan.

A 29-year-old man was admitted to our hospital because of recurrence of diffuse large B-cell lymphoma (DLBCL), which was initially treated with chemotherapy. Gallium scintigraphy showed abnormal accumulation in the apex of the heart, which suggested cardiac involvement of DLBCL. The thoracic CT, MRI, and transthoracic echocardiography also revealed the existence of an apical mass (Figure), and the ECG showed giant negative T waves in leads V₃ through V₆. The treatment, which consisted of high-dose methotrexate, cytarabine, and rituximab, was effective, and CT showed regression of the size of the apical mass. The giant negative T waves virtually disappeared simultaneously. Two months later, however, CT demonstrated regrowth of the apical mass, with reappearance of giant negative T waves on the ECG. Creatine kinase-MB was not increased during this course. The mechanisms of the giant negative T wave can be diverse. In this case, no alteration was observed in the QRS complex, and the QTc interval was almost stable during the course of treatment. Alternation of transmural ventricular repolarization is a possible cause of the appearance of giant negative T waves, and the repolarization abnormality of the ventricle could be a marker of cardiac involvement of DLBCL.

View larger version (90K): [in this window] [in a new window]   Time course of CT and ECG. A, Before recurrence of DLBCL (May 2003). B, At the time of diagnosis of cardiac involvement of DLBCL (April 2004). C, After methotrexate, cytarabine, and rituximab therapy (May 2004). D, Regrowth of apical mass (arrows) (July 2004). Apical mass and giant negative T waves are visualized in B. Regression of apical mass in conjunction with disappearance of negative T waves is shown in C. The recurrence of both apical mass and giant negative T waves was evident in D (arrows).

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Circulation 2005 112: 3025. [Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ito, M. Articles by Aizawa, Y. Search for Related Content PubMed PubMed Citation Articles by Ito, M. Articles by Aizawa, Y. Related Collections Electrocardiology CT and MRI Related Article