Ann Thorac Surg 2009;87:644. doi:10.1016/j.athoracsur.2008.05.060
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Giant Thymolipoma Causing Cardiocompressive Syndrome With Chronic Heart Failure
Anna Lerro, MD*,
Giuseppe De Luca, MD
Department "Heart," "Pineta Grande Clinical Institute," Castel Volturno, Caserta, Italy
* Address correspondence to Dr Lerro, Via Diocleziano, 178, Naples, 80125, Italy (Email: cardiothorax.pineta{at}libero.it).
A 33-year-old man was admitted to our hospital complaining of dry cough, progressive dyspnea with oxygen saturation of 94% on 50% face mask oxygen. The patient was pale in a cold sweat, agitated with blood pressure of 90/50 mm Hg and a heart rate of 110 beats/min. His past clinical history was not remarkable. Physical examination revealed neck vein distension, slight inferior limbs edemas, and complete absence of vesicular breath sounds in the right hemithorax.
A two-dimensional transthoracic echocardiogram revealed a huge and heterogeneous extracardiac mass (white arrow), that was compressing the right atrium and ventricle, reducing the cavitary diameters (Fig 1;
LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle). This mediastinal mass was causing a cardiac failure. A chest computed tomographic scan showed a noncontrast-enhancing tumor of 27 x 20 x 12 cm in size (gray arrows), with areas of fat density and areas of soft-tissue density. It occupied the entire right side of the chest, determining significant compression of the heart and collapse of the lung (Figs 2A and 2B). The patient was rushed to the operating room. General anesthesia was carried out and the surgical access was made through a median sternotomy. The tumor did not involve the neighboring structures and complete resection was performed. The surgery revealed a giant thymolipoma of 3,450 g. The postoperative period was uneventful, and the patient was discharged home on postoperative day 6.
Thymolipoma is a rare, benign, and slow-growing tumor of the anterior mediastinum that accounts for 2% to 9% of thymic tumors. Thymolipoma incidence is seen in approximately 12 per 100,000 cases of inhabitants per year with no sexual predominance being observed [1]. Most patients are asymptomatic and some cases are discovered as huge anterior mediastinal masses on chest roentgenogram.
Complications associated with thymolipoma include myasthenia gravis, anaplastic anemia, Hodgkin's disease, hypogamma–globulinemia and hyperthyroidism [2]. In our case the mass compressed the heart causing hemodynamic alterations.
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References
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- Roque C, Rodriguez P, Quintero C, Santana N, Hussein M, Freixinet J. Giant thymolipoma Arch Bronconeumol 2005;41:402-403.[Medline]
- Takahashi H, Harada M, Kimura M, Kato H. Thymolipoma combined with hyperthyroidism discovered by neurological symptoms Ann Thorac Cardiovasc Surg 2007;13:114-117.[Medline]
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G. Y, V. Yadala, N. Y, A. Dal, and A. D. Raju
Huge mediastinal mass with minimal symptoms: thymolipoma
BMJ Case Reports,
March 24, 2011;
2011(mar16_1):
bcr0520102984 - bcr0520102984.
[Abstract]
[Full Text]
[PDF]
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