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A Rare Presentation of Thymoma as a Giant Intrathoracic Mass FREE TO VIEW

Bikash Bhattarai, MD; Frances Marie Schmidt, MD; Meenakshi Ghosh, MBBS; Abhisekh Sinha Ray, MBBS; Ashna Pokhrel, MBBS; Saveena Manhas, MD; Prakash Kharel, MBBS; Vikram Oke, MBBS; Rawshan Ali Basunia, MBBS; Chidozie Agu, MD; joseph Quist, MD; Danilo Enriquez, MD
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Interfaith Medical Center, Brooklyn, NY

Chest. 2015;148(4_MeetingAbstracts):502A. doi:10.1378/chest.2275760
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SESSION TITLE: Imaging Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Thymoma is an uncommon neoplasm that originates from the epithelial cells of the thymus and accounts for more than 50% of all anterior mediastinal masses. Large intrathoracic thymomas are extremely rare and very few cases have been reported. We report a case of thymoma presenting as a giant intrathoracic mass

CASE PRESENTATION: A 46 year old African American male with a past medical history of 20 pack year smoking history presented with cough productive of green sputum, exertional shortness of breath with decreased functional capacity (1 block) and an associated 60lbs weight loss over 12 months with night sweats. He also complained of weakness in his legs after one block of walking. On presentation vitals were stable. Examination was positive for left sided chest dullness and reduced air entry with associated crepitations in the left basilar area. There was bilateral lower leg weakness with hyporeflexia but sensation was intact. Labs were positive for leukocytosis (14,500), anemia (Hbg: 11.3), thrombocytosis (465,000) and mild renal insufficiency (creatinine: 1.4). Chest x-ray had nearly complete opacification of the left hemithorax with mediastinal shift to the right. He was admitted for the management of post-obstructive pneumonia and to rule out pulmonary tuberculosis. Vancomycin and meropenem were started and the patient initially put on airborne isolation. CT chest was done and reported as large, heterogeneous, bulky masses nearly occupying the entire left hemithorax with mediastinal shift along with multiple liver lesions. His symptoms improved with antibiotics and pulmonary TB was ruled out. Old medical records obtained from previous hospitalization indicated that he had inoperable thymoma (diagnosed in 2007, s/p chemotherapy in 2010 and 2013) and myasthenia gravis managed with pyridostigmine.

DISCUSSION: Thymoma is an epithelial neoplasm of the thymus, which lies in the anterior mediastinum, it rarely presents in the thorax. About 30% patients with invasive disease have Myasthenia Gravis as a paraneoplastic syndrome. Surgical resection is the standard of care for both non-invasive and invasive thymomas, but for metastatic disease and inoperable tumors like our patient, adjunctive therapy (chemotherapy and radiation) is used

CONCLUSIONS: High index of suspicion for thymoma should be present when patients present with anterior mediastinal/ intrathoraic mass and symptoms of myasthenia gravis

Reference #1: 1. Detterbeck FC, Parsons AM: Thymic tumors. Ann Thorac Surg 2004, 77:1860-9

DISCLOSURE: The following authors have nothing to disclose: Bikash Bhattarai, Frances Marie Schmidt, Meenakshi Ghosh, Abhisekh Sinha Ray, Ashna Pokhrel, Saveena Manhas, Prakash Kharel, Vikram Oke, Rawshan Ali Basunia, Chidozie Agu, joseph Quist, Danilo Enriquez

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