Ayuna Ahmed, Ahmad Saad, Alam Sjirjel, Abidin Nik
Salford Royal NHS Foundation Trust, Manchester, UK.
Manchester Universities Foundation Trust, Manchester, UK.
Egypt Heart J. 2021 Jul 2;73(1):60. doi: 10.1186/s43044-021-00178-1.
Thymic 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.
Our 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.
TET 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.
胸腺上皮肿瘤（TET）是成人前纵隔最常见的肿瘤。心脏受累通常局限于心包，心脏内受累罕见。我们报告了一例独特的病例，巨大纵隔肿瘤包裹并移位左前降支冠状动脉，导致心肌缺血。
我们的患者是一名28岁的4期TET女性。她因急性胸痛就诊，伴有12导联心电图改变及肌钙蛋白I系列显著升高。多模态心脏成像显示巨大纵隔肿瘤包裹并移位左前降支冠状动脉。CT-FFR显示有缺血证据，这可以解释她的急性表现。在心脏病专家、肿瘤学家和心胸外科医生进行详细的多学科讨论后，决定对该女性进行姑息化疗。鉴于肿瘤侵犯范围及初始治疗失败，她的预后及结局较差。
TET可导致心房受压、心肌浸润以及肺静脉和腔静脉受侵；然而，据我们所知，这是首例报道的TET导致冠状动脉移位和包裹的病例。
