J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://jh.elmerpub.com

Case Report

Volume 15, Number 5, October 2026, pages 248-254

A Case of Classic Hodgkin Lymphoma With Biventricular Myocardial Involvement

↓ Figure 1. Contrast-enhanced CT (a) and contrast-enhanced ECG-gated MRI (b–d) imaging of mediastinal masses before therapy. (a) Coronal image shows a large anterior mediastinal mass (10.3 cm in length). (b) Coronal image shows a left ventricular mass with middle and superficial myocardial involvement (yellow arrow). (c) Coronal image shows a right ventricular outflow tract mass (blue arrow). (d) Coronal image shows a great vessel mass compressing the pulmonary arteries (orange arrow). CT: computed tomography; ECG: electrocardiogram; MRI: magnetic resonance imaging.

↓ Figure 2. FDG PET/CT coronal images of the mediastinal masses, with SUV scale. Coronal images show (a) significant lesion metabolic activity prior to chemotherapy, and (b) significant reduction in activity following one cycle of CHOP and two cycles of A + AVD. A + AVD: brentuximab plus doxorubicin, vinblastine, and dacarbazine; CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone; CT: computed tomography; FDG: fluorodeoxyglucose; PET: positron emission tomography; SUV: standardized uptake value.

↓ **Table 1.** Timeline of Diagnostic Evaluation, Treatment, and Follow-Up
Day	Clinical event
A + AVD: brentuximab plus doxorubicin, vinblastine, and dacarbazine; CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone; CT: computed tomography; FDG: fluorodeoxyglucose; LVEF: left ventricular ejection fraction; MRI: magnetic resonance imaging; PET: positron emission tomography.
Day 0	Initial presentation, CT, and hospital admission
Day 1	Initial transthoracic echocardiogram: ejection fraction of 45%, pericardial effusion up to 1.8 cm
Day 2	Cardiac MRI
	Left axillary lymph node core biopsy performed
	Bone marrow biopsy performed; negative for lymphoma involvement
Day 10	Preliminary biopsy pathology became available: aggressive B-cell lymphoma with features suggestive of classic Hodgkin lymphoma; morphology was not definitive and raised the possibility of mediastinal gray zone lymphoma. Bone marrow negative for lymphoma involvement
Day 12	Left axillary lymph node excisional biopsy
Day 14	Initial FDG PET/CT
	Empiric CHOP, cycle 1 day 1
Day 21	Repeat echocardiogram: LVEF 55% and 1.5-cm reduction in left ventricular tumor diameter
Day 24	Final excisional biopsy pathology confirmed classic Hodgkin lymphoma, nodular sclerosis subtype; definitive staging and IPS-7 assessment completed.
Day 25	Discharged from initial hospitalization with outpatient medical oncology follow-up arranged
Day 36	A + AVD, cycle 1 day 1
Day 40	Syncopal episode prompting emergency presentation; right pulmonary artery thrombus and extensive superior vena cava thrombosis identified. Admitted to hospital.
	Repeat CT: marked reduction in cardiac masses, complete resolution of pericardial effusion
Day 55	Discharged from second hospitalization
Day 91	Repeat FDG PET/CT
Day 251	Final chemotherapy infusion, A + AVD cycle 6 day 15
Day 308	Post-treatment FDG PET/CT

↓ Table 1. Timeline of Diagnostic Evaluation, Treatment, and Follow-Up

Day

Clinical event

A + AVD: brentuximab plus doxorubicin, vinblastine, and dacarbazine; CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone; CT: computed tomography; FDG: fluorodeoxyglucose; LVEF: left ventricular ejection fraction; MRI: magnetic resonance imaging; PET: positron emission tomography.

Day 0

Initial presentation, CT, and hospital admission

Day 1

Initial transthoracic echocardiogram: ejection fraction of 45%, pericardial effusion up to 1.8 cm

Day 2

Cardiac MRI

Left axillary lymph node core biopsy performed

Bone marrow biopsy performed; negative for lymphoma involvement

Day 10

Preliminary biopsy pathology became available: aggressive B-cell lymphoma with features suggestive of classic Hodgkin lymphoma; morphology was not definitive and raised the possibility of mediastinal gray zone lymphoma. Bone marrow negative for lymphoma involvement

Day 12

Left axillary lymph node excisional biopsy

Day 14

Initial FDG PET/CT

Empiric CHOP, cycle 1 day 1

Day 21

Repeat echocardiogram: LVEF 55% and 1.5-cm reduction in left ventricular tumor diameter

Day 24

Final excisional biopsy pathology confirmed classic Hodgkin lymphoma, nodular sclerosis subtype; definitive staging and IPS-7 assessment completed.

Day 25

Discharged from initial hospitalization with outpatient medical oncology follow-up arranged

Day 36

A + AVD, cycle 1 day 1

Day 40

Syncopal episode prompting emergency presentation; right pulmonary artery thrombus and extensive superior vena cava thrombosis identified. Admitted to hospital.

Repeat CT: marked reduction in cardiac masses, complete resolution of pericardial effusion

Day 55

Discharged from second hospitalization

Day 91

Repeat FDG PET/CT

Day 251

Final chemotherapy infusion, A + AVD cycle 6 day 15

Day 308

Post-treatment FDG PET/CT

↓ **Table 2.** Summary of Selected Published Cases of Cardiac Involvement by Classic Hodgkin Lymphoma
Source (year)	Age/sex	Confirmation of diagnosis	Cardiac involvement	Presenting feature	Treatment	Outcome
F: female; FDG: fluorodeoxyglucose; LV: left ventricle; LVEF: left ventricular ejection fraction; M: male; PET: positron emission tomography; RVOT: right ventricular outflow tract; SVC: superior vena cava; PA: pulmonary artery; SVT: supraventricular tachycardia.
[3] (1989)	—	—	Intra-atrial	Neoplastic intra-atrial thrombosis	—	Recurrence at 18 months
[5] (2005)	27/F	Mediastinoscopy and lymph node biopsy	Left atrium; pulmonary vein compression	SVT, heart failure, pulmonary hypertension	Chemotherapy not otherwise specified	Cardiac findings and arrhythmia improved
[6] (2010)	8/F	Cervical lymph node biopsy	Diffuse cardiac tissue and septum	Heart failure, pericardial effusion	Doxorubicin/bleomycin/vincristine/dacarbazine	No evidence of disease at 1 year
[11] (2020)	14/F	Diagnostic pericardial-region core biopsy after nondiagnostic transcatheter biopsy	Right atrial mass extending into SVC and left innominate vein	Dyspnea; tricuspid inflow obstruction	Doxorubicin/bleomycin/vincristine/etoposide/cyclophosphamide/prednisone	Mass decreased; PET became FDG-negative
[2] (2023)	18/M	Mediastinal mass biopsy	Bilateral atrial walls and right atrial chamber	Chest pain, large pericardial effusion, tamponade physiology	Doxorubicin/bleomycin/vinblastine/dacarbazine + pericardiocentesis + radiotherapy	Complete remission > 3 years
[7] (2025)	34/M	Lymph node biopsy	Interventricular septum; global LV dysfunction	Sinus tachycardia, LVEF 36%	Doxorubicin/vinblastine/dacarbazine/brentuximab	LVEF improved from 36% to 47%
[10] (2025)	17/M	Cervical lymph node biopsy	Superior right atrial wall and interatrial septum	Sinus node dysfunction	Doxorubicin/vincristine/etoposide/methylprednisolone, followed by vincristine/dacarbazine/cyclophosphamide/methylprednisolone	Arrhythmia resolution by day 21; dimensional and metabolic regression within 2 months
Presented case	31/M	Axillary lymph node excisional biopsy	LV free wall and RVOT	Chest pain, reduced LVEF, pericardial effusion; later syncope/bradycardia with SVC/PA thrombosis	Doxorubicin/vincristine/cyclophosphamide/prednisone, followed by doxorubicin/vinblastine/dacarbazine/brentuximab	No evidence of disease at 1 year

↓ Table 2. Summary of Selected Published Cases of Cardiac Involvement by Classic Hodgkin Lymphoma

Source (year)

Age/sex

Confirmation of diagnosis

Cardiac involvement

Presenting feature

Treatment

Outcome

F: female; FDG: fluorodeoxyglucose; LV: left ventricle; LVEF: left ventricular ejection fraction; M: male; PET: positron emission tomography; RVOT: right ventricular outflow tract; SVC: superior vena cava; PA: pulmonary artery; SVT: supraventricular tachycardia.

[3] (1989)

—

Intra-atrial

Neoplastic intra-atrial thrombosis

—

Recurrence at 18 months

[5] (2005)

27/F

Mediastinoscopy and lymph node biopsy

Left atrium; pulmonary vein compression

SVT, heart failure, pulmonary hypertension

Chemotherapy not otherwise specified

Cardiac findings and arrhythmia improved

[6] (2010)

8/F

Cervical lymph node biopsy

Diffuse cardiac tissue and septum

Heart failure, pericardial effusion

Doxorubicin/bleomycin/vincristine/dacarbazine

No evidence of disease at 1 year

[11] (2020)

14/F

Diagnostic pericardial-region core biopsy after nondiagnostic transcatheter biopsy

Right atrial mass extending into SVC and left innominate vein

Dyspnea; tricuspid inflow obstruction

Doxorubicin/bleomycin/vincristine/etoposide/cyclophosphamide/prednisone

Mass decreased; PET became FDG-negative

[2] (2023)

18/M

Mediastinal mass biopsy

Bilateral atrial walls and right atrial chamber

Chest pain, large pericardial effusion, tamponade physiology

Doxorubicin/bleomycin/vinblastine/dacarbazine + pericardiocentesis + radiotherapy

Complete remission > 3 years

[7] (2025)

34/M

Lymph node biopsy

Interventricular septum; global LV dysfunction

Sinus tachycardia, LVEF 36%

Doxorubicin/vinblastine/dacarbazine/brentuximab

LVEF improved from 36% to 47%

[10] (2025)

17/M

Cervical lymph node biopsy

Superior right atrial wall and interatrial septum

Sinus node dysfunction

Doxorubicin/vincristine/etoposide/methylprednisolone, followed by vincristine/dacarbazine/cyclophosphamide/methylprednisolone

Arrhythmia resolution by day 21; dimensional and metabolic regression within 2 months

Presented case

31/M

Axillary lymph node excisional biopsy

LV free wall and RVOT

Chest pain, reduced LVEF, pericardial effusion; later syncope/bradycardia with SVC/PA thrombosis

Doxorubicin/vincristine/cyclophosphamide/prednisone, followed by doxorubicin/vinblastine/dacarbazine/brentuximab

No evidence of disease at 1 year