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.