대한흉부영상의학회 Weekly Chest Cases

Case No : 453 Date 2006-07-03

Courtesy of Sung Koo Woo, MD., Yeon Joo Jeong, MD., Kun-Il Kim, MD. / Busan National University Hospital, Busan, Korea
Age/Sex 72 / M
Chief ComplaintProgressive dyspnea and facial edema

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Diagnosis With Brief Discussion

Diagnosis: Thymic Carcinoma with Intraluminal Growth to the Bilateral Branchiocephalic Veins, Azygos vein, SVC & RA
Radiologic Findings: Mediastinal windows of transverse contrast-enhanced chest CT scan show a heterogenously enhancing anterior mediastinal mass with lobulated contour & central necrosis. Also note the enhancing mass filled the lumen of bilateral brachiocephalic veins, azygos vein, superior vena cava (SVC) & right atrium.
Brief Review: Thymic tumors commonly invade the capsule and the adjacent organs. Local invasion occurs most commonly into the pleura (30%), pericardium (25%), lungs (8%), and recurrent laryngeal nerve (4%), but invasion into the intracardiac and great vessels is extremely rare (1). SVC obstruction is commonly caused by extrinsic compression of the tumor, but less commonly intraluminal growth to large vessels (2).

According to Koji et al (3), the thymic veins that drain the LBCV may be possible entrance routes of the tumor. The tumor cells might have entered through them and grown downstream to the RA with the blood flow.
References: 1. Filippone G, Savona I, Tomasello V, Guzzetta P, Zarcone N, Agate V. Radical excision of invasive thymoma with intracaval and intracardial extension: a successful case report. J Cardiovasc Surg (Torino). 1997;38:547-9.

2. Airan B, Sharma R, Iyer KS, Kalia PK, Singh MK, Shrivastava S, Rao IM. Malignant thymoma presenting as intracardiac tumor and superior vena caval obstruction. Ann Thorac Surg. 1990;50:989-91.

3. Yamazaki K, Takeo S, Takeshita M, Sugimachi K. Thymic carcinoma presenting as an intraluminal growth into the great vessels and the cardiac cavity. Ann Thorac Cardiovasc Surg. 2002;8:163-6.
Keywords: Mediastinum, Vascular, Malignant tumor,

No. of Applicants : 38

▶ Correct Answer : 8/38, 21.1%

- Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Nirman Hitech Diagnostic Center, Mumbai, India Minal Seth
- Maimonides Medical Center, New York, USA Naomi Twersky
- Samsung Medical Center, Korea Yulri Park
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
- ROK Airforce Hyun Seok Choi
- Doctors Hospital, Nassau, Bahamas N.B.S.Mani

▶ Correct Answer as Differential Diagnosis : 11/38, 28.9%

- Pgimer, Chandigarh, India Ram Prakash Galwa
- Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung
- University of Colorado Health Sciences Center, USA Seth Kligerman
- Monaldi Hospital Naples, Italy Gaetano Rea
- Kashan University of Medical Sciences, Kashan, Iran Ebrahim Razi
- Sam Anyang Hospital, Korea Jae Seung Seo
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- EKH-Berlin, Germa Michael Weber
- China Medical University Hospital,Taiwan Jun-Jun Yeh
- Max Hospital , Saket, New Delhi, India Anurag Jain
- Max Hospital, New Delhi, India Vickrant Malhotra

▶ Semi-Correct Answer : 6/38, 15.8%

- National Taiwan University Hospital, Taiwan Yu-Feng Wei
- Pgimer, Chandigarh, India Krishna Prasad S
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Zulekha Hospital, Dubai Saurabh Khandelwal
- Zulekha Hospital, Dubai Julie Arora
- MGM, Indore, India Sonali Jain

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 453 Date 2006-07-03

Discussion

No. of Applicants : 38