Case history
Case history
A 55-year-old man presents to the emergency department with atypical chest pain. A computed tomography pulmonary angiogram shows no pulmonary embolism but demonstrates a 4 cm homogeneous anterior mediastinal mass. The patient is otherwise healthy, with no significant past medical history. Physical exam and routine blood tests are all normal.
Other presentations
Approximately one third of patients with thymoma are asymptomatic, with the tumor discovered incidentally on imaging.[7] Another one third of patients present with symptoms related to compression of thoracic structures. Large or invasive thymomas may present with cough or vague chest pain. Dyspnea is often a presenting sign and can be due to a large space-occupying tumor, consequent pleural effusion, or phrenic nerve paralysis.
Rarely, patients may present with features suggestive of superior vena cava syndrome (e.g., facial and upper extremity edema) due to extrinsic tumor compression and invasion or intravascular tumor thrombus. Left-arm swelling due to invasion and obstruction of the left innominate vein is a rare presenting sign. Finally, 40% of patients with thymoma present with an associated autoimmune paraneoplastic syndrome, most commonly myasthenia gravis.[8][9] Some 10% to 15% of patients with myasthenia gravis have an associated thymoma.[10] Therefore, muscle weakness involving ocular, facial, oropharyngeal and respiratory, and/or limb muscles may be evident at presentation.
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