Chonnam Med J.  2011 Dec;47(3):177-180. 10.4068/cmj.2011.47.3.177.

Cause of Chest Pain in a Patient with Previous Myocardial Infarction: Look Outside the Heart for Extracardiac Mass

• Lee DI
• Kim SA
• Kang JH
• Lee JH
• Park SJ
• Yoon DW
• Shim WJ
• Park SM

• KMID: 2172229
• DOI: http://doi.org/10.4068/cmj.2011.47.3.177

Abstract

We report a case of thymic carcinoma that was initially detected by echocardiography in an 80-year-old male who visited the emergency room for chest pain and had a history of myocardial infarction and percutaneous coronary intervention. Transthoracic echocardiography showed a huge extracardiac mass that was located in the anterior mediastinum and was diagnosed as a thymic carcinoma by biopsy.

Keyword

Chest pain; Echocardiography; Molecular Weight

MeSH Terms

Aged, 80 and over
Biopsy
Chest Pain
Echocardiography
Emergencies
Heart
Humans
Male
Mediastinum
Molecular Weight
Myocardial Infarction
Percutaneous Coronary Intervention
Thorax
Thymoma

Figure

• 

  FIG. 1 Chest radiograph showed mild cardiomegaly and mediastinal widening.

• 

  FIG. 2 Hypoechogenic mass (arrow) was shown in the parasternal long axis view (A) and short-axis view at the level of the aortic valve (B).The vascularity of the mass was documented in color flow imaging in the zoom view (C). M: mass, RV: right ventricle, LV: left ventricle, LA: left atrium, AV: aortic valve, PA: pulmonary artery.

• 

  FIG. 3 Echocardiography in the parasternal long axis view (A) and short axis view at the level of the aortic valve (B) 1 year previously showed no echogenic material in the retrosternal area.

• 

  FIG. 4 Contrast-enhanced computerized tomography showed a heterogeneously enhancing mass (arrow) in the left anterior mediastinum abutting the aortic arch and pulmonary artery with sternal and costal cartilage.

• 

  FIG. 5 Using a microscope with 100× magnification, the great majority of cells had tumoral necrosis and a very small number of cells had a high nucleus to cytoplasm ratio with hyperchromatin.

Reference

1. Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000. 342:1163–1170.

2. Swinburn JM, Stubbs P, Soman P, Collinson P, Lahiri A, Senior R. Independent value of tissue harmonic echocardiography for risk stratification in patients with non-ST-segment elevation acute chest pain. J Am Soc Echocardiogr. 2002. 15:1031–1037.

3. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005. 128:2893–2909.

4. Ozer N, Can I, Aytemir K, Atalar E, Erman M, Ovünç K, et al. Malignant thymoma invading the right atrium: a rare echocardiographic finding. Echocardiography. 2002. 19:61–62.

5. D'Cruz IA, Feghali N, Gross CM. Echocardiographic manifestations of mediastinal masses compressing or encroaching on the heart. Echocardiography. 1994. 11:523–533.

6. Canedo MI, Otken L, Stefadouros MA. Echocardiographic features of cardiac compression by a thymoma simulating cardiac tamponade and obstruction of the superior vena cava. Br Heart J. 1977. 39:1038–1042.

7. Woldow A, Kotler M, Goldstein S, Milcu M. Thymoma with pericardial tamponade. Clin Cardiol. 1995. 18:484–485.

8. Sadohara J, Fujimoto K, Müller NL, Kato S, Takamori S, Ohkuma K, et al. Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol. 2006. 60:70–79.

9. Seto H, Kageyama M, Shimizu M, Wu YW, Kamei T, Kakishita M. Assessment of residual tumor viability in thymic carcinoma by sequential thallium-201 SPECT: comparison with CT and biopsy findings. J Nucl Med. 1994. 35:1659–1661.