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JAMA Surgery Clinical Challenge
November 2016

Fatty Tumor Compressing the Heart

Author Affiliations
  • 1Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois
JAMA Surg. 2016;151(11):1081-1082. doi:10.1001/jamasurg.2016.1008

A man in his 40s training for weight-lifting presented with new-onset progressive dizziness, lightheadedness, and shortness of breath. His medical and family history as well as review of other systems were unremarkable. Physical examination revealed a positive Kussmaul sign and pulsus paradoxus but no cardiac murmurs. There was no pedal edema, clubbing, or cyanosis. An electrocardiogram demonstrated sinus tachycardia. Results of a complete blood cell count and biochemical panel were within reference ranges. A chest radiograph revealed convexity on the right heart border suggestive of cardiomegaly (Figure 1A). Echocardiography demonstrated normal cardiac chambers and valves. However, an echogenicity was noted compressing the superior vena cava and right ventricle. The patient subsequently underwent computed tomographic imaging of the chest that revealed a large, 16.2 × 6.8 × 5.6-cm anterior mediastinal mass compressing the right cardiac structures, particularly the superior vena cava. The mass consisted mostly of fat attenuation, but was interspersed with nodular densities (Figure 1B). Tumor marker levels, including α-fetoprotein, lactate dehydrogenase, and β-human chorionic gonadotropin, were within reference ranges.

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