Abstract
A 17-yr-old, 56-kg male was referred to our institution with a 2-wk history of left-sided stabbing chest pain, cough, and progressive dyspnea. The patient was initially evaluated in the emergency room of a nearby hospital where chest radiography demonstrated a left-sided chest mass. The patient’s medical history was significant for asymptomatic mitral valve prolapse without mitral regurgitation. Diagnostic evaluation included a chest computed tomography (CT) scan with a needle-guided biopsy and a transthoracic echocardiogram. The CT scan results confirmed a highly vascular anterior mediastinal mass measuring 10 cm and compressing the left mainstem bronchus and the pulmonary artery. The biopsy results confirmed a malignant germ-cell tumor. Chemotherapy was initiated, yet the patient’s dyspnea increased over 2 days. Transthoracic echocardiogram confirmed compression of the right ventricular outflow tract (RVOT) and main pulmonary artery (maximal systolic dimension was 4 mm with complete diastolic collapse). Peak Doppler velocity through the pulmonary arteries was 3 m/s. A moderately sized apical pericardial effusion was also noted. The patient was urgently taken to the operating room for surgical resection with cardiopulmonary bypass. Intraoperative transesophageal echocardiography
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