Case history
Case history
A 55-year-old man presents to the emergency department with atypical chest pain. A computed tomography pulmonary angiogram shows no pulmonary embolism but demonstrates a 4 cm homogeneous anterior mediastinal mass. The patient is otherwise healthy, with no significant past medical history. Physical examination and routine blood tests are all normal.
Other presentations
Approximately one third of patients with thymoma are asymptomatic, with the tumour discovered incidentally on imaging.[7] Another one third of patients present with symptoms related to compression of thoracic structures. Large or invasive thymomas may present with cough or vague chest pain. Dyspnoea is often a presenting sign and can be due to a large space-occupying tumour, consequent pleural effusion, or phrenic nerve paralysis.
Rarely, patients may present with features suggestive of superior vena cava syndrome (e.g., facial and upper extremity oedema) due to extrinsic tumour compression and invasion or intravascular tumour thrombus. Left-arm swelling due to invasion and obstruction of the left innominate vein is a rare presenting sign. Finally, 40% of patients with thymoma present with an associated autoimmune paraneoplastic syndrome, most commonly myasthenia gravis.[8][9] Some 10% to 15% of patients with myasthenia gravis have an associated thymoma.[10] Therefore, muscle weakness involving ocular, facial, oropharyngeal and respiratory, and/or limb muscles may be evident at presentation.
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