Abstract
BackgroundThymic epithelial tumour (TET) is the most common tumour affecting the anterior mediastinum in adults. The cardiac extension is often limited to the pericardium, and intracardiac extension is rare. We present a unique case of encasement and displacement of the left anterior descending coronary artery by the large mediastinal tumour leading to myocardial ischemia.Case presentationOur patient is a 28-year-old lady with stage 4 TET. She presented with acute chest pain associated with 12-lead ECG changes and a significant rise in serial troponin I. Multimodality cardiac imaging revealed encasement and displacement of the left anterior descending coronary artery by the large mediastinal tumour. CT-FFR demonstrates evidence of ischemia which would account for her acute presentation. Following detailed MDT discussions between cardiologists, oncologists and cardiothoracic surgeons, the decision was made to treat this lady with palliative chemotherapy. Given the extent of the tumour invasion and failure of the initial therapy, her prognosis and the outcome were poor.ConclusionsTET could cause atrial compression, myocardial infiltration, and invasion of the pulmonary and caval veins; however, to the best of our knowledge, this is the first case reported of coronary artery displacement and encasement by TET.
Highlights
ConclusionsThymic epithelial tumour (TET) could cause atrial compression, myocardial infiltration, and invasion of the pulmonary and caval veins; to the best of our knowledge, this is the first case reported of coronary artery displacement and encasement by TET
Thymic epithelial tumour (TET) is the most common tumour affecting the anterior mediastinum in adults
TET could cause atrial compression, myocardial infiltration, and invasion of the pulmonary and caval veins; to the best of our knowledge, this is the first case reported of coronary artery displacement and encasement by TET
Summary
TET is a common mediastinal tumour, but cardiac involvement is rare. To the best of our knowledge, this is the first case report of a patient with TET presenting with cardiac chest pain as a consequence of encasement and displacement of the coronary artery by an enlarging TET. This case highlights the importance of cardiac and chest imaging in making the diagnosis and guiding treatment options and follow-up care
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