History and exam
Key diagnostic factors
common
myasthenia gravis
10% to 15% of patients with myasthenia gravis have an associated thymoma.[8]
muscle weakness
Suggests myasthenia gravis. Ocular weakness (double vision, drooping eyelids) may be the only presenting feature. Generalised weakness, particularly facial and oropharyngeal weakness (difficulty in chewing, dysphagia, or dysarthria), as well as proximal limb weakness (difficulty with getting out of chairs or climbing stairs) may be present. In patients with myasthenic crisis, respiratory muscle weakness results in severe respiratory involvement.
uncommon
facial and upper extremity oedema
Suggests superior vena cava syndrome. May also occur in lymphoma and germ cell tumours.
facial plethora
Suggests superior vena cava syndrome. Due to venous engorgement and oedema.
distended veins in the neck, chest, and/or abdominal wall
Suggests superior vena cava syndrome.
left-arm swelling
Due to invasion and obstruction of the left innominate vein.
Other diagnostic factors
uncommon
cough
Usually mild and non-productive without haemoptysis. May also occur in lymphoma and germ cell tumours.
dyspnoea
Non-specific symptom; usually mild. Marked dyspnoea, particularly when supine or flexed at the waist, can be due to phrenic nerve invasion with elevated, dysfunctional hemidiaphragm. May also occur in lymphoma and germ cell tumours.
fever and/or weight loss
Rare, non-specific systemic symptoms. Fever and/or weight loss are common in lymphoma.
Risk factors
strong
history of myasthenia gravis
10% to 15% of patients with myasthenia gravis have an associated thymoma.[8]
weak
age >45 years
The peak age of incidence of a thymoma is between 45 and 65 years; the mean age for thymic carcinoma is 46 years.[8] The age of the patient can be useful in discriminating between thymoma and lymphoma because lymphoma usually arises in patients aged under 35 years or over 65 years. Thymoma in patients under the age of 40 is uncommon.[17]
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