Houston Methodist Hospital, Houston, Texas, US.
Howard University Hospital, Washington, DC.
Methodist Debakey Cardiovasc J. 2021 Oct 19;17(3):18-23. doi: 10.14797/mdcvj.516. eCollection 2021.
A 61-year-old man presented to the emergency room with lower extremity edema. Physical exam was only remarkable for a diastolic murmur in the right carotid area and left lower extremity edema. Venous Doppler revealed a deep venous thrombosis in the left lower extremity. Chest computed tomography (CT) with intravenous contrast ruled out pulmonary embolism but showed a mediastinal mass adjacent to the pericardium. Further imaging with cardiac magnetic resonance imaging (CMR) and cardiac CT angiography (CCTA) enabled localization and evaluation of the structural characteristics of the mass. The decision was made to excise the mass due to increasing size compared with its measurements on prior chest CTs and a high degree of vascularization seen on CMR and CCTA, which was concerning for an enlarging arteriovenous malformation or a hemangioma. However, histopathologic analysis of the mass revealed it to be a micronodular thymoma.
一位 61 岁男性因下肢水肿到急诊就诊。体格检查仅在右侧颈动脉区有舒张期杂音和左侧下肢水肿。静脉多普勒超声显示左侧下肢深静脉血栓形成。胸部 CT 增强扫描排除了肺栓塞，但显示心包旁纵隔有一个肿块。进一步的心脏磁共振成像（CMR）和心脏 CT 血管造影（CCTA）使肿块的定位和结构特征评估成为可能。由于与先前胸部 CT 相比肿块增大，且 CMR 和 CCTA 显示高度血管化，考虑到进行性增大的动静脉畸形或血管瘤的可能性，决定切除该肿块。然而，肿块的组织病理学分析显示为微结节性胸腺瘤。
