PMC3403161_01
CT scan of chest shows the cysts compressing the right ventricle anteriorly (large arrows) and the cyst behind the heart compressing the left atrium posteriorly (small arrows).
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fig1
Repeated CT of the chest showed multiple cystic masses impinging on the right ventricle and left atrium described as metastasis in concordance with his history of malignant thymoma (Figure 1).
Echocardiography shows the cystic mass surrounding the heart (full arrows) with impingement on the right ventricle and left atrium.
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fig2
He presented to our institution where echocardiography showed two large anterior fluid collections one of which was compressing the right ventricle with a third cyst behind the left atrium (Figure 2).
Photomicroscopy of the Gram stain of the aspirated fluid from the cystic masses shows the Gram-positive branching rods indicating the presence of Nocardia spp.
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fig3
The Gram stain showed Gram-positive branching rods, and the recovered Nocardia spp. was identified in Laboratories Cerba France as N. asiatica (Figure 3).