Undifferentiated Primary Mediastinal Carcinoma Compressing the Main Pulmonary Artery: A Rare Cause of Right Ventricular Strain

Document Type

Conference Proceeding

Publication Date

4-2-2024

Publication Title

Journal of the American College of Cardiology

Abstract

Background: The most common anterior mediastinal masses are thymomas, lymphomas, germ cell tumors, congenital cysts, and retrosternal goiter. Approximately 10% are undifferentiated carcinomas. Case: A 60-year-old male with HIV on antiretroviral therapy and hepatitis B presented with 1-week of midsternal chest pain, weight loss, night sweats, and weakness. Vital signs were BP 120/80 mm Hg and HR 80 BPM. Examination revealed JVD and distant heart sounds. Initial echocardiogram (Figure) displayed large posterior pericardial effusion and normal RV function. He was admitted to CCU for hemodynamic monitoring. The posterior location of the effusion made pericardiocentesis challenging. The patient underwent a pericardial window. Pre-operative chest CT demonstrated 10 cm anterior mediastinal mass with pericardial invasion. CT-guided biopsy revealed undifferentiated carcinoma. Decision-making: The patient developed postoperative atrial fibrillation with RVR and hypotension managed with cardioversion. BP did not respond to fluid resuscitation. Due to ensuing cardiogenic shock, repeat ECHO revealed severe RV enlargement and strain with RV/LV ratio of 1.5 (Figure). The patient improved with emergent radiotherapy and platinum-based chemotherapy. He was discharged home with further follow-up. Conclusion: The etiology of RV strain is broad. Mediastinal neoplasms with mass effect on the pulmonary artery and RV strain require rapid identification and initiation of treatment.

Volume

83

Issue

13 Suppl

First Page

3216

Comments

American College of Cardiology 73rd Annual Scientific Session & Expo, April 6-8, 2024, Atlanta, GA

DOI

10.1016/S0735-1097(24)05206-9

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