Bui Hoang, Helms Jessica L, Sierra-Hoffman Miguel, Stevens Mark L, Deliz-Aguirre Rafael, Castro-Lainez Miriams T, Deliz Rafael J
Texas A&M Detar Family Residency Program, Victoria, TX, 77901, USA.
Detar Medical Group, 605 E. San Antonio St, Suite 310E, Victoria, TX, 77901, USA.
Respir Med Case Rep. 2020 Apr 3;30:101049. doi: 10.1016/j.rmcr.2020.101049. eCollection 2020.
A 38-year-old African American male presented with progressive pain, swelling, numbness, and warmth of the left upper extremity ten days before admission. A chest computerized tomography scan showed a large 8.3 cm × 6.1 cm x 9.9 cm anterior mediastinal mass with compression of the left brachiocephalic vein and superior vena cava. A venous doppler showed multiple occlusive venous thrombi in bilateral upper extremities, including the bilateral internal jugular and subclavian veins, as well as the left subclavian, axillary, cephalic, brachial and median cubital veins. Further laboratory workup came positive for acetylcholine receptor binding antibody suggesting myasthenia gravis, but the patient was asymptomatic for myasthenia gravis. A percutaneous core CT guided biopsy pathology resulted in a predominant T-cell population CD5 positive with few B cells; the immunophenotypic features suggested Type B2 thymoma. To the best of our knowledge, this case is the only reported thymoma presenting with bilateral deep vein thrombosis of the upper extremities. The deep vein thrombosis therapy was enoxaparin 1mg/kg subcutaneously every 12 hours and dexamethasone 4mg intravenously every 4 hours as an anti-inflammatory drug for thymoma related compression of the mediastinum. The patient was referred to a tertiary oncological medical center for a total thymectomy, chemotherapy, and adjuvant radiotherapy.
一名38岁非裔美国男性在入院前10天出现左上肢进行性疼痛、肿胀、麻木和发热。胸部计算机断层扫描显示前纵隔有一个8.3 cm×6.1 cm×9.9 cm的大肿块，压迫左头臂静脉和上腔静脉。静脉多普勒检查显示双侧上肢有多处闭塞性静脉血栓形成，包括双侧颈内静脉和锁骨下静脉，以及左锁骨下静脉、腋静脉、头静脉、肱静脉和肘正中静脉。进一步的实验室检查发现乙酰胆碱受体结合抗体呈阳性，提示重症肌无力，但该患者无重症肌无力症状。经皮CT引导下穿刺活检病理显示以CD5阳性的T细胞为主，B细胞较少；免疫表型特征提示为B2型胸腺瘤。据我们所知，该病例是唯一报告的伴有双侧上肢深静脉血栓形成的胸腺瘤。深静脉血栓形成的治疗方案为每12小时皮下注射依诺肝素1mg/kg，每4小时静脉注射地塞米松4mg作为抗炎药物，用于治疗与胸腺瘤相关的纵隔压迫。该患者被转诊至三级肿瘤医学中心进行全胸腺切除术、化疗和辅助放疗。
