原发性心脏弥漫性大 B 细胞淋巴瘤 (CDLBCL) 是一种极其罕见的实体，估计占所有原发性心脏肿瘤的不到 1%。在本病例报告中，我们强调了多模态成像的诊断重要性以及对伴有心脏压塞的原发性心脏淋巴瘤病例进行组织活检等额外手术的必要性。一名 80 岁男性因急诊入院科室有危及生命的填塞物，要求立即进行胸骨切开术。术前超声心动图显示心包积液和心尖增厚。虽然计算机断层扫描排除了主动脉夹层，但手术发现右心室和心尖处有一个意想不到的富含血管的肿块，对于活检来说太危险了。术后影像学将该肿块误认为是良性血肿。随后，患者被送入重症监护室，但经过保守治疗策略后，患者死亡。尸检显示原发性 CDLBCL。该病例证明了原发性 CDLBCL 的欺骗性，通常并发心脏压塞。它强调了病理评估的关键作用，即使在胸骨切开术的危险中，也能确定异常心脏肿块的起源。医生必须提高认识，因为这种难以捉摸的诊断可能会被忽视，从而导致潜在的致命后果。© 作者 2024。由牛津大学出版社代表欧洲心脏病学会出版。

Primary cardiac diffuse large B-cell lymphoma (CDLBCL) is an exceptionally rare entity, estimated to represent less than 1% of all primary cardiac tumours. In this case report, we emphasize the diagnostic importance of multimodality imaging and the need for additional procedures, such as tissue biopsy, in a case with a primary cardiac lymphoma presenting with cardiac tamponade.An 80-year-old male was admitted to the emergency department with a life-threatening tamponade demanding immediate sternotomy. Pre-operative echocardiography unveiled pericardial effusion and a thickened apex. While computed tomography ruled out an aortic dissection, surgery revealed an unexpected vascular-rich mass at the right ventricle and apex, too perilous for biopsy. Post-operative imaging misinterpreted this mass as a benign haematoma. Subsequently, the patient was admitted to the intensive care unit, but after a conservative treatment strategy, the patient died. An autopsy revealed a primary CDLBCL.This case demonstrates the deceptive nature of primary CDLBCL, often complicated by cardiac tamponade. It underscores the pivotal role of pathologic assessment, even amidst the perils of sternotomy, to determine the origin of abnormal cardiac masses. A heightened awareness among physicians is imperative, for such elusive diagnoses may slip by, with potentially fatal outcomes.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.