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Lung Cancer |

Anterior Mediastinal Thymoma Compressing the Right Ventricular Outflow Tract (RVOT) Causing Syncope!

Vidushi Sharma*, MD; Christine Rohr, DO; Susan Sallach, MD; Butchi Babu Paidipaty, MD; Marilyn Haupt, MD
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Synergy Medical Education Alliance, Saginaw, MI


Chest. 2012;142(4_MeetingAbstracts):580A. doi:10.1378/chest.1364374
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Abstract

SESSION TYPE: Cancer Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: The comman Anterior mediastinal masses found in the anterior mediastinum are thymomas, lymphomas, germ cell tumors, congenital cysts, intrathoracic thyroid tissue, and parathyroid lesions1. Common clinical presentations of the mediastinal masses include dyspnea on exertion, arrhythmias, right-sided heart failure, pericarditis, pericardial effusion, and syncope.1 Thymomas represent 20 percent of all mediastinal neoplasms in adults and is found in 15 percent of patients with myasthenia gravis.

CASE PRESENTATION: This is a 34 year old female with 2 year history of palpitations, dizziness , syncopal episode. She had been assessed in outside facility with tilt table, stress testing, and holter monitor evaluation. Due to positive tilt table test and finding of non sustained ventricular tachycardia, she was recommended to have electrophysiology evaluation and pacemaker implantation. A second opinion recommended cardiac MRI to exclude arrthymogenic right ventricular dysplasia, which demonstrated a small circumferential pericardial effusion, and anterior mediastinal mass compressing the right ventricular outflow tract, CT guided biopsy confirmed type A thymoma. Resection via median sternotomy revealed a 8-9 cm x4-5 cm thymoma invading the pericardium which was removed. The postoperative period was uneventful and the patient was discharged home.

DISCUSSION: The anterior mediastinal masses which may cause pressure effects on the ventricles causes ventricular tachycardia are thymoma, teratoma or lymphoma. Thymoma is a tumor originating from the epithelial cells of the thymus which can cause RVOT Tachycardia without any structural heart disease causing syncope.2 Anterior mediastinal masses can be surgically removed, hence reversing the symptoms of recurrent episodes of ventricular tachycardia and syncope.

CONCLUSIONS: Compression induced Ventricular Tachycardia is generally considered to have an excellent prognosis as the symptoms resolve with resection of the mediastinal mass resection.3

1) Ann Thorac Surg 1987;44:229-237: Primary Cysts and Neoplasms of the Mediastinum: Recent Changes in Clinical Presentation, Methods of Diagnosis, Management, and Results. R. Duane Davis, Jr., M.D., H. Newland Oldham, Jr., M.D., David C. Sabiston, Jr., M.D. Department of Surgery, Duke University Medical Center, Durham, NC

2) N Engl J Med. 1986 Jun 26;314(26):1711. Thymoma-induced syncope. Ben-Chetrit E, Ben-Yehuda A, Ackerman Z, Burstein M.

3) J Clin Oncol. 1999 Jul;17(7):2280-9. Thymoma: state of the art. Thomas CR, Wright CD, Loehrer PJ.Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA.

DISCLOSURE: The following authors have nothing to disclose: Vidushi Sharma, Christine Rohr, Susan Sallach, Butchi Babu Paidipaty, Marilyn Haupt

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Synergy Medical Education Alliance, Saginaw, MI

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