Non-Hodgkin lymphoma is the most frequent cause of secondary involvement of the heart in children at autopsy [1]. During life, patients can present with pericardial effusions, chest pain, conduction disturbances, and congestive heart failure due to myocardial infiltration [2][3][4]. Myocardial infarctions due to infiltration of the myocardium as well as compression of a coronary artery have been reported [5]. The occurrence of an acute ischaemic death directly after the aspiration of a lymphomatous pericardial effusion, as occured in one of our patients, has to our knowledge not yet been described. The history of our case follows.
An 11-year-old boy with a mediastinal mass was referred with cardiac tamponade. He had a two-month history of worsening fatigue, anorexia, weight loss, and an irritating cough. Clinical examination revealed a pale distressed child with sinus tachycardia, raised jugular venous pressure, hepatomegaly, and a palpable pulsus paradoxus. In addition, the heart sounds were soft and he had signs of a left-sided pleural effusion. There were no clinical signs of tracheal compression or superior vena cava syndrome. The accompanying chest X-ray films and computerised axial tomographic scan showed a large solid tumour in the anterior mediastinum extending to the left hemithorax, as well as the left-sided pleural effusion. At echocardiography, there was a large pericardial effusion with evidence of chamber collapse and a ''swinging heart.'' A large mass surrounded the great vessels. Contractility of both ventricles was normal. The clinical and radiologic diagnosis was that of lymphoma. However, because of rapid clinical deterioration, urgent pericardial aspiration with ultrasound guidance was performed under general anaesthesia. This was done using the Seldinger technique from a subxiphoidal approach. Immediate clinical improvement followed the removal of 100 ml of serous fluid. The heart rate decreased from 140/min to 110/min, and peripheral perfusion improved. Approximately 5 min after the aspiration of fluid, the child developed ST-segment elevation suggesting acute ischaemia, followed by bradycardia and hypotension. Intravenous colloids and dopamine were administered, but irreversible collapse ensued.
An echocardiogram performed during the resuscita-tion showed that the right ventricle was now markedly dilated, hypokinetic, and compressed the left ventricle.