Cardiothoracic Surgery: Cardiology and Cardiothoracic Surgery |

Invasive Thymoma: Intracaval Invasion and Extension Into the Right Ventricle FREE TO VIEW

Sameer Chadha, MD; Ankur Lodha, MD; Adnan Sadiq, MD; Jacob Shani, MD
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Maimonides Medical Center, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A51. doi:10.1016/j.chest.2016.02.054
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SESSION TITLE: Cardiology and Cardiothoracic Surgery

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: We report a rare case of an Invasive Thymoma in a 56 year old male. The mediastinal tumor in our patient was invading the superior vena cava (SVC), and through the SVC, the tumor was extending into the right atrium and right ventricle, reaching up to the pulmonic valve.

CASE PRESENTATION: A 56 year old male presented to our emergency department with complaints of worsening shortness of breath and pleuritic chest pain. The Chest X-ray showed widening of the mediastinum but no infiltrates or pleural effusion. A CT chest was performed which revealed an 8 x 5.5 x 5 cm heterogeneous mass in the anterior mediastinum along with superior vena cava infiltration and extension of the mass into the right atrium (Figure A). The echocardiogram revealed further extension of the tumor from the right atrium to the right ventricle, up to the pulmonic valve (Figure B). The mass was partially obstructing both tricuspid and pulmonic valves. A biopsy of the mass was performed which came back consistent with an ‘Invasive Thymoma’. The patient was offered surgery but he refused any aggressive measures despite counseling.

DISCUSSION: Thymomas account for around 20 percent of all mediastinal neoplasms. They are usually diagnosed as an incidental finding on radiographic studies but can present with chest pain, shortness of breath, SVC obstruction or paraneoplastic syndrome (most commonly myasthenia gravis) [1]. The metastatic involvement of the heart is more common than primary cardiac tumors. The metastasis can occur via direct invasion from the mediastinum, hematogenous spread or rarely, as in our patient, infiltration into the vena cava and then extension into the right atrium.

CONCLUSIONS: Although rare, Invasive Thymoma, should be considered while evaluating a right atrial mass.

Reference #1: 1. Safieddine N, Liu G, Cuningham K, et al. Prognostic factors for cure, recurrence and long-term survival after surgical resection of thymoma, J Thorac Oncol. 2014 Jul;9(7):1018-22.

DISCLOSURE: The following authors have nothing to disclose: Sameer Chadha, Ankur Lodha, Adnan Sadiq, Jacob Shani

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