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August 1983

Atypical Chest Pain With a Systolic Murmur

Author Affiliations

From the Department of Medicine, Sections of Internal Medicine (Drs Bomalaski and Martin) and Cardiology (Dr Mehlman), Northwestern Memorial Hospital, Chicago.

Arch Intern Med. 1983;143(8):1583-1585. doi:10.1001/archinte.1983.00350080101022

A 32-year-old man complained of chest discomfort. He had been well during the preceding months except for retrosternal pain related to anxiety or external chest compression. Sarcoidosis had been diagnosed three years previously on the basis of bilateral hilar lymphadenopathy on chest roentgenogram with abnormal pulmonary function test results. Physical examination was remarkable for left supraclavicular lymphadenopathy, a new 2/6 systolic ejection murmur at the cardiac base, and a two component pericardial friction rub. An echocardiogram (Fig 1) was performed.

What is your diagnosis?

Diagnosis.  —Anterior Mediastinal Mass (Seminoma).Anterior to the aorta at the level of the aortic valve one expects to see an echo-free space representing the right ventricular outflow tract. Instead, the M-mode echocardiogram (Fig 1) shows an area of dense echoes due to a mass anterior to the heart. The extent of the anterior mediastinal mass is better delineated by the two-dimensional echocardiographic views (Fig 2).

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