Major Crush: a Solitary Fibrous Pleural Tumor
A 78-year-old woman’s diagnosis truly weighed heavily on her heart. The patient presented with a history of increasing dyspnea over the previous 2 months, and this was accompanied by a dry cough and occasional right scapular pain. She denied fever, sweats, or weight loss. Her medical history included diabetes and hypertension, but she had no prior hospital admissions.
On examination, the patient had tachycardia (124 beats/min), tachypnea (18 breaths/min), and hypoxemia (91% saturation on room air). She had decreased breath sounds and fremitus over the right hemithorax. Results from laboratory tests were unremarkable. However, a chest x-ray showed a large mass (Figure 1).
Computed tomography confirmed the presence of a tumor, disclosing a circumscribed mass, measuring 15.5 × 13.5 × 9.5 cm, in the patient’s right anterior mediastinum. The growth was compressing her heart, trachea, and major blood vessels (Figure 2). Calcifications and right pleural effusion were noted. No metastases were evident. A percutaneous biopsy was performed.
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– Ami Schattner, MD, Nadia Sokolovski, MD, Edward Altman, MD, Meital Adi, MD
This article originally appeared in the August 2013 issue of The American Journal of Medicine.
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