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A 60 year old woman was referred to our hospital complaining of swelling of the face. Seven years before admission she underwent a thoracotomy for thymoma. The resection of the tumour seemed to be complete, and no adjuvant treatment was given. Five months before admission she complained of oedema and intermittent flushing of the face. The clinical diagnosis was superior vena cava syndrome.
Computed tomography of the chest revealed no mediastinal adenopathy or parenchymal lesions, but rather thrombosis of the superior vena cava. Superior venacavography showed an enormous mass extending from the distal portion of the vena cava into the right atrium. Transthoracic echocardiography was negative, while transoesophageal echography showed a very large mass within the right atrium and superior vena cava. Thoracotomy was difficult because of previous surgery. A tumour arising from the internal wall of the superior vena cava extending into the right atrium was removed with difficulty after incision of the atrium and vena cava. Pathology confirmed lymphoepithelial thymoma with spindle cells and moderate lymphocytic reaction.
This case seems to be the first description of thymoma recurrence within the superior vena cava and right atrium, seven years after the initial manifestation of thymoma; this underlines the long and insidious evolution of this tumour. It also demonstrates the usefulness of transoesophageal echocardiography in superior vena cava syndrome for detecting mediastinal or cardiac masses.