2017, Number 3
Rev Fac Med UNAM 2017; 60 (3)
Espinoza SER, Serrano OSC
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ABSTRACTIntroduction: According to the international references of a classical autopsy review by Straus and Merliss, its incidence was of 0, 0017-0, 28%, while Lymburner found only 4 cases in 8,500 autopsies, resulting of an incidence of 0.05%, and finally Nadas and Ellison found one case for every 10,000 autopsies1. Thymoma is tumor located mainly in the anterior mediastinum ,90% of the cases, because of the position of the thymic gland, this does not exclude that in a very low percentage level it can appear in the middle or posterior mediastinum, the neck, the base of the skull, the lung parenchyma, the pleural cavity and the intra pericardial location but it is rarer and constitutes a real challenge to be diagnosed as well as its surgical management.
Clinical case: A 23-year-old male with a history of smoking, alcoholism and drug addiction, arrives with dyspnea of medium efforts that evolves into small efforts, retro-sternal pain, cough, sputum, not quantified weight loss, tachycardia, tachypnea, use of accessory muscles, decreased vesicular murmur in the left lung.
Evolution: The following complementary studies were performed: thorax radiography, chest angio CT, echocardiogram and a biliary pulmonary tumor diagnosis was concluded, his surgical treatment was decided by means of posterolateral thoracotomy. Evidence shows of a large tumor involving the right ventricle and the anterior aspect of the pulmonary artery. Resection of intrapericardial thymoma is performed.
Conclusions: Intrapericardial thymomas constitute very rare pathologies. In the case of being of primary origin, they are characterized by no evidence of thymus involvement and no symptoms of Myasthenia Gravis. Diagnostic suspicion, accompanied by timely treatment, is the basis for the management of these patients. Surgical treatment despite being a challenge is the best option, even in those cases that are used as a cytoreductor method.