Isolated shortness of breath in a woman with a history of Hodgkin lymphoma

Abstract

Background: Isolated shortness of breath in the patient with a history of a malignancy creates a diagnostic challenge and serves as a source of anxiety. Although cancer recurrence is typically the first concern of the patient and the clinician, toxicities of anticancer therapies must also be considered.

Methods: A case of a 49-year-old woman with a distant history of Hodgkin lymphoma with 2 months of progressive dyspnea is presented and discussed.

Results: Although the patient was found to have bilateral pleural and pericardial effusions that were concerning for a recurrence of malignancy, analysis and cytology of fluids were negative for cancer. Instead a diagnosis of effusive-constrictive pericarditis secondary to radiation therapy was made.

Conclusion: When treating a patient with a history of malignancy who presents with dyspnea, it is important to consider the downstream effects related to cancer treatments, even decades later, to guide specific therapies and to assuage the patient's fears.

Keywords: anxiety; constrictive pericarditis; dyspnea; malignancy; radiation therapy; shortness of breath.