Complex redo surgery to treat a large thymoma invading the right atrium.

Abstract

Anterior mediastinal masses which invade the great vessels and heart are rare. We report a case of a 76-year-old male presenting with a large invasive anterior mediastinal mass following recent cardiac surgery (coronary artery bypass grafting and aortic valve replacement via sternotomy). This is a case report study with clinical patient information retrieved from hospital electronic records. Computed tomography scanning revealed a large heterogeneous 6.5 × 7.2 × 7.0 cm right anterior mediastinal mass. The mass directly propagated via the left innominate vein into the superior vena cava (SVC) and proximal right atrium. The patient underwent redo sternotomy with the aid of cardiopulmonary bypass and hypothermic circulatory arrest to remove the mass. The mass was sitting in the right pleural cavity and was adherent to the right lung and pericardium. Tumor material was removed from the right atrium, SVC and left innominate vein. The mass was excised en bloc along with a portion of the upper lobe of the right lung. Histology of the mass revealed the diagnosis of invasive type A thymoma with transvenous and transcardiac invasion. We advocate for surgeons to be aggressive in their operative resection of such tumours to ensure the best prognostic outlook for the patient.