25023062 Visualization

A 66 Age - year Age - old Age Caucasian Personal_background woman Sex with a history of hypertension History was admitted Clinical_event to our hospital Nonbiological_location with a recent diagnosis of Burkitt Disease_disorder lymphoma Disease_disorder .
Her lactate Diagnostic_procedure dehydrogenase Diagnostic_procedure level was high Qualitative_concept and the diameter of her mediastinal Biological_structure mass Sign_symptom was more Distance than Distance 10cm Distance .
Her physical Diagnostic_procedure examination Diagnostic_procedure was normal Lab_value , and basal Detailed_description electrocardiography Diagnostic_procedure ( ECG Diagnostic_procedure ) showed sinus Sign_symptom rhythm Sign_symptom with a heart Diagnostic_procedure rate Diagnostic_procedure of 72 Lab_value beats/minute Lab_value .
Two Diagnostic_procedure - dimensional Diagnostic_procedure transthoracic Diagnostic_procedure echocardiography Diagnostic_procedure ( TTE Diagnostic_procedure ; Siemens Detailed_description , Acuson Detailed_description Sequoia Detailed_description , C512 Detailed_description ) revealed normal Lab_value biventricular Diagnostic_procedure functions Diagnostic_procedure with an LV Diagnostic_procedure ejection Diagnostic_procedure fraction Diagnostic_procedure ( LVEF Diagnostic_procedure ) of 60% Lab_value , mild Severity mitral Biological_structure and tricuspid Biological_structure regurgitation Sign_symptom , and moderate Severity pericardial Sign_symptom effusion Sign_symptom .
A risk Diagnostic_procedure assessment Diagnostic_procedure of the patient put her into a high Qualitative_concept - risk Qualitative_concept category and she underwent rituximab Medication - hyperfractionated Medication - cyclophosphamide Medication - vincristine Medication - doxorubicin Medication - dexamethasone Medication ( R Medication - Hyper Medication - CVAD Medication ) chemotherapy Medication protocol.
Her laboratory Diagnostic_procedure values Diagnostic_procedure are summarized in Table 1.
She received high Dosage - dose Dosage cyclophosphamide Medication 300mg/m2 Dosage twice Dosage daily Dosage for 3 Duration days Duration , doxorubicin Medication 25mg/m2/day Dosage for 2 Duration days Duration , rituximab Medication 375mg/m2/day Dosage for 1 Duration day Duration , dexamethasone Medication 40mg/day Dosage for 4 Duration days Duration , and vincristine Medication 2mg/day Dosage for 2 Duration days Duration .
The total treatment dose of cyclophosphamide Medication and doxorubicin Medication received was 1800mg/m2 Dosage and 50mg/m2 Dosage , respectively.
She was given allopurinol Medication 300mg/day Dosage perorally Administration , sodium Medication bicarbonate Medication ( 8.4% Dosage , 10 Dosage flacon/day Dosage ) infusion Administration for 24 Duration hours Duration before Duration chemotherapy Medication , and mesna Medication 600mg/m2/day Dosage for 2 Duration days Duration as prophylaxis Therapeutic_procedure against tumor Disease_disorder lysis Disease_disorder syndrome Disease_disorder and hemorrhagic Disease_disorder cystitis Disease_disorder , respectively.
She also received granisetron Medication 2mg/day Dosage and lansoprazole Medication 30mg/day Dosage as antiemetogenic Detailed_description and gastric Biological_structure prophylaxis Therapeutic_procedure , respectively.
The patient developed dyspnea Sign_symptom on the seventh Date day Date of therapy.
A physical Diagnostic_procedure examination Diagnostic_procedure revealed blood Diagnostic_procedure pressure Diagnostic_procedure of 100/60mmHg Lab_value and a heart Diagnostic_procedure rate Diagnostic_procedure of 110 Lab_value beats/minute Lab_value .
On chest Biological_structure auscultation Diagnostic_procedure , no inspiratory Sign_symptom sounds Sign_symptom were heard at lower Biological_structure zones Biological_structure and inspiratory Sign_symptom crackles Sign_symptom were heard at middle Biological_structure zones Biological_structure .
Neither cardiac Sign_symptom murmurs Sign_symptom nor S3 Sign_symptom were heard.
An ECG Diagnostic_procedure showed low Lab_value voltage Lab_value in the limb Diagnostic_procedure and Diagnostic_procedure precordial Diagnostic_procedure leads Diagnostic_procedure .
TTE Diagnostic_procedure showed diffusely Lab_value increased Lab_value myocardial Biological_structure echogenicity Diagnostic_procedure , mild Severity pericardial Sign_symptom effusion Sign_symptom , and generally Lab_value impaired Lab_value biventricular Detailed_description systolic Diagnostic_procedure functions Diagnostic_procedure with an LVEF Diagnostic_procedure 31% Lab_value and right Biological_structure ventricular Biological_structure mid Detailed_description - apical Detailed_description akinesis Sign_symptom .
Manifest Detailed_description pleural Sign_symptom effusion Sign_symptom was also detected.
Drug Disease_disorder - induced Disease_disorder cardiotoxicity Disease_disorder ( myocarditis Disease_disorder ) was suspected.
Furosemide Medication and ramipril Medication were started.
The beta Medication - blocker Medication therapy the patient was already taking for hypertension Sign_symptom was continued.
After Date 12 Date days Date , TTE Diagnostic_procedure showed an LVEF Diagnostic_procedure of 37% Lab_value and normal Lab_value right Diagnostic_procedure ventricular Diagnostic_procedure functions Diagnostic_procedure .
Her dyspnea Sign_symptom decreased and she was discharged Activity on day Date 20 Date .
After Date 1 Date month Date , TTE Diagnostic_procedure showed normal Lab_value biventricular Diagnostic_procedure functions Diagnostic_procedure with an LVEF Diagnostic_procedure of 60% Lab_value .
After the first course of the R Medication - Hyper Medication - CVAD Medication chemotherapy Medication protocol, she underwent a high Dosage - dose Dosage methotrexate Medication and cytarabine Medication cycle.
She had severe neutropenia Sign_symptom and pneumonia Disease_disorder .
She had no cardiac Sign_symptom failure Sign_symptom symptoms Sign_symptom during this chemotherapy Medication course, but she declined another Detailed_description course Detailed_description of chemotherapy Medication .
She is still in remission Sign_symptom despite the abbreviated course of chemotherapy Medication .