PMC3806362_01
CT scan of the chest with contrast reveals a large lobulated anterior mediastinal solid mass (black arrow) with extension into the right hemithorax and the right atrium. There is displacement of the great vessels into the left hemithorax with significant mass effect on the right upper lobe. The tumor causes compression of the right pulmonary artery (red arrow) and right and left mainstem bronchi (white arrows).
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fig1
Follow-up contrast enhanced chest CT revealed a large lobulated anterior mediastinal mass near the right atrium with complete encasement and effacement of the superior vena cava (SVC) and invasion into the right atrium (Figures 1 and 2).
Coronal CT scan image elucidates a mediastinal mass with extension into the right atrium (black arrow) with complete encasement and compression of the SVC. The tumor extends to the confluence of the IVC in the right atrium causing dilatation of the intraabdominal IVC and hepatic veins suggesting compromised cardiac return (red arrows). Tumor causes the displacement of great vessels into the left hemithorax.
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fig2
Follow-up contrast enhanced chest CT revealed a large lobulated anterior mediastinal mass near the right atrium with complete encasement and effacement of the superior vena cava (SVC) and invasion into the right atrium (Figures 1 and 2).
A comprehensive 2 dimensional M-mode color flow and Doppler echocardiography reveals a normal left ventricular systolic function (EF 60-69%). A large right atrial mass measuring 5.8 x 4.7 cm almost fills the right atrium and extends into the tricuspid valve causing tricuspid regurgitation.
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fig3
A transthoracic echocardiogram demonstrated a mass with erosion through the SVC and extension through the endocardium and into the right atrium up to the tricuspid valve annulus resulting in regurgitation (Figure 3).
Cardiac MRI short axis T1 at the level of mitral valve reveals a large mediastinal mass infiltrating and obliterating the SVC causing SVC obstruction. The tumor extends into the right atrium (red arrow) and invades the tricuspid valve. Maximum diameter of the mediastinal mass measures 15 x 10 cm, and the mass in the right atrium measures 5.8 x 5.3 cm.
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An MRI defined a 15 x 10 cm anterior mediastinal mass infiltrating through the myocardium into the right atrial lumen, associated with complete SVC obstruction (Figure 4). 