Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 22/04/2025
This article have been viewed 1271 times
Case 19
A 65-year-old man had abnormalities on his electrocardiogram (ECG) at a routine outpatient office visit with his primary physician. He was referred for exercise stress/rest myocardial perfusion imaging.
He exercised for 9 minutes, 15 seconds, achieving 10 METs with Bruce protocol. His heart rate changed from 55 beats/min to 135 beats/min (achieving 87% target) and blood pressure from 150/70 to 190/90 mm Hg. Resting ECG showed sinus rhythm with left anterior fascicular block and nonspecific ST-T changes in limb leads. No chest pain or ST-segment change occurred on stress. Patient underwent stress-rest 99mTc-sestamibi perfusion imaging.
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Perfusion imaging showed a small area of perfusion abnormality involving the inferolateral wall, which was reversible on rest images. Left ventricular ejection fraction (LVEF) was 61%. There was a large nodular area of radiotracer uptake in the right lung in the mediastinum, which was suspicious for thymoma, ectopic thyroid tissue, or some other malignant mass such as lymphoma.
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Coronary angiogram showed bilateral coronary calcifications, with luminal irregularities in distal left anterior descending (LAD) and proximal large first obtuse marginal, and focal 50% stenosis in proximal right coronary artery (RCA).
Computed tomography scan of the patient’s chest showed an anterior mediastinal mass measuring 3.8 × 2.5 cm. He underwent thoracotomy and excision of the mediastinal mass, which proved to be a thymoma.
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