Abstract: The authors present the case of a 40-year-old female with a massive anterior mediastinal tumor who presented with acute respiratory distress. She required emergent intubation and ventilatory support for respiratory compromise caused by lung compression. Preoperative computed tomographic scan results suggested a mediastinal lipomatous mass. Resection of the tumor resulted in immediate improvement in her pulmonary status. Because thymolipomas can attain enormous dimensions and compress adjacent structures, they should be resected at the time of diagnosis.
Key Words: anterior mediastinal mass, thymic neoplasms, thymolipoma
Thymolipoma is a rare benign tumor of thymic origin that can achieve massive proportions before symptoms occur. These tumors account for 2 to 9% of thymic neoplasms, (1) with the majority being reported in children and young adults. (2) In young children, upper respiratory symptoms may develop because of their more compliant upper airways. (3, 4) However, most of the adult patients have no symptoms referable to the tumor, and are diagnosed after routine radiographic imaging. (5) This case illustrates the slow but progressive enlargement of these tumors, and the need for timely resection once diagnosis is made.
A 40-year-old, morbidly obese female presented with severe dyspnea that had progressed over a period of 3 days. She also complained of productive cough, but had no fever or chest pain. Her medical history included bronchial asthma, obstructive sleep apnea, and tobacco abuse. In addition, 5 years before this admission, a computed tomographic (CT) scan performed after an abnormal chest radiograph revealed anterior mediastinal lipomatosis. Because she was asymptomatic at that time, the caring physician elected not to pursue further treatment. Physical examination revealed morbid obesity, facial hirsutism, diffuse expiratory wheezing, altered mental status, and pitting lower extremity edema. Initial vital signs included...
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