CASE PRESENTATION
A 69-year-old female with an unremarkable past medical history was
evaluated due to recent dyspnea on excessive physical activity and
declined functional capacity. She had been experiencing recurrent left
upper chest pain for five months, unrelated to trauma. She has
occasional coughs, but no weight loss or history of tumors was reported.
She is hypothyroid and has occasional sweating. The patient has no
cardiac murmurs, signs of heart failure, or palpable lymphadenopathy.
Chest computed tomography (CT) revealed an anterior mediastinal mass
measuring 13.4 x 9.1 cm with moderate to large pericardial effusion, a
15 mm subcarinal lymph node was also seen [Figure 1A ]. The
mass contained heterogeneous calcifications with extension into the
pericardium and the right pleural space. There was extrinsic compression
of the superior vena cava, without significant obstruction
[Figure 1B ]. Echocardiography showed moderate pericardial
effusion without signs of tamponade [Figure 2A and 2B ]. The
patient remained hemodynamically stable without evidence of tamponade
physiology, jugular venous distension, or pulsus paradoxus, emergent
pericardiocentesis was not indicated.