Dor torácica por compressão atrial direita por timolipoma

Abstract

484On physical examination, the patient was hydrated, acyanotic, anicteric, eupneic, afebrile, with healthy coloring, in regular general condition, and had neither jugular venous distension nor peripheral edema. His blood pressure was 140/100 mmHg and his heart rate was 120 bpm. His pulses were palpable, symmetric, rhythmic, with no changes in peripheral perfusion. The ictus cordis was located on the fifth left intercostal space, at the level of the left midclavicular line, and had approximately 2 digital pulps. The cardiac sounds had normal intensity and no cardiac murmur was heard. On pulmonary auscultation, the respiratory sounds were present bilaterally, and no rales were heard. The abdomen was flat, flaccid with hydro-aerial noises, not tender on palpation, and no visceromegaly was observed.The biochemical tests and electrocardiogram showed no changes. On chest radiography, a mild enlargement of the cardiac area was observed with an expanding lesion in the anteroinferior mediastinum, in continuity with the cardiac image ( fig.1). The esophagogram showed no signs of extrinsic compression of the esophagus. Upper digestive endoscopy showed only a mild enanthematous antral gastritis.Transthoracic echodopplercardiography showed a mild extrinsic compression of the anterolateral region of the right atrium. The transesophageal echocardiogram confirmed this compression with no significant hemodynamic repercussions, and the presence of a mild systolic reflux (escape) in the tricuspid valve ( fig. 2).To complement the investigation, the patient underwent chest computed tomography performed with 5-and 10-mm-thick axial sections after intravenous infusion of contrast medium. The tomography revealed the presence of an expanding lesion with a fat attenuation coefficient, regular and precise contours, located in the anterior mediastinum to the right, slightly deviating from the right atrium posteriorly. The lesion measured 12.0 x 7.4 x 9.6 cm and was suggestive of thymolipoma or pericardial lipoma ( fig. 3).With these hypotheses, the patient was referred for surgical treatment. Thoracotomy provided complete excision of the tumoral mass, which weighed approximately 580 g. No regional macroscopic metastases were evident, and later anatomicopathological examination confirmed the diagnosis of thymolipoma (fig. 4).