A case of cardiac tamponade shock due to bleeding from an advanced thymoma
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CASE REPORT
A case of cardiac tamponade shock due to bleeding from an advanced thymoma Minoru Okamoto • Mutsuo Tanaka • Yasuhiro Tamori Yoshio Haga • Toshihiko Murayama
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Received: 3 September 2012 / Accepted: 16 November 2012 Ó The Japanese Association for Thoracic Surgery 2012
Abstract Although thymomas are the most common anterior mediastinal neoplasm, those causing cardiac tamponade are unusual. To the best of our knowledge, only 13 cases have been proven in the English literature We report thymoma in a 66-year old man that caused cardiac tamponade, for which he underwent an emergency operation. On admission, he presented in a shocked state; his echocardiography results revealed pericardial effusion. Computed tomography scan indicated a thymoma infiltrating the right lung. Initially, pericardial drainage was performed through puncture; however, cardiac tamponade recurred next day. Pericardial drainage, thymectomy, and pericardiectomy were performed, but the tumor was incompletely resected. On postoperative day 2, right upper lobectomy was attempted but discontinued because of the impossibility to manipulate the pulmonary hilum, which was suspected to have tumor infiltration. He was discharged on the 27th day after the first operation, is alive at 10 months after surgery, and is under chemotherapy.
M. Okamoto M. Tanaka (&) Department of Cardiovascular Surgery, National Hospital Organization Kumamoto Medical Center, 1–5 Ninomaru, Chuou-ku, Kumamoto 860-0008, Japan e-mail: [email protected] Y. Tamori Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan Y. Haga Institution for Clinical Research, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan T. Murayama Department of Pathology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
Keywords Thymoma Mediastinal tumor Cardiac tamponade
Introduction Thymomas are the most common neoplasm in the anterior mediastinum. Thymomas are usually asymptomatic; however, one-third of the patients manifest symptoms owing to tumor compression or invasion. Among the complications of thymomas, cardiac tamponade is unusual. The prognosis of thymomas is based on staging and histological classification. The only treatment option is complete surgical resection. Here, we report a rare case of a patient with thymoma complicated by cardiac tamponade.
Case A 66-year-old man with chest pain and dyspnea was transferred to a primary hospital by ambulance. Echocardiography results revealed pericardial effusion. In addition, computed tomography (CT) scans revealed an anterior mediastinal tumor (Fig. 1). Therefore, he was referred to our institution for emergency treatment. On arrival at our institution, he had a blood pressure of 86/69 mmHg, and a heart rate of 154 beats/min. Arterial blood gas analysis under oxygen (administered through a face mask; flow, 10 L/min) gave the following results: pH 7.370, PaCO2 24.0 mmHg, and PaO2 75.0 mmHg. Immediately, a drainage tube was placed into the pericard
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