M2 ANATOMY

A 38 year old patient of yours is seeing you in clinic for a follow-up regarding her benign thymoma which was diagnosed incidentally one week earlier via an MRI for a herniated thoracic disk.  The patient is scheduled for surgical removal of the tumor the following week. 

The patient is in good spirits, though she is somewhat apprehensive about the upcoming surgery. While talking to her about what to expect, you perform a thorough physical exam. During the examination, you notice that she has slight swelling of her face and neck. Close examination also reveals similar swelling of her upper limbs, bilaterally. No swelling is noticed in the abdominal body wall or lower limbs. Detailed questioning reveals that the patient just recently also noticed these same symptoms but attributed them to working outside more in the summer heat. The patient does, however, reveal to you that she has also recently noticed that she is slightly short of breath when performing normal activities of daily living. She also reveals that she has developed a cough in the past few days despite having no history of allergies or recent upper respiratory infections. She denies chest pain and hemoptysis, and her skin tone looks normal (with no evidence of purple or discolored skin or nail beds). 

Given your knowledge of the patient’s tumor location in the mediastinum as well as its extension posteriorly toward the right posterior body wall and neck root, you strongly suspect that the thymoma is impinging upon important structures and giving the patient her current symptoms. You reassure your patient that her surgery will likely alleviate all these symptoms but that you will also consult with the surgical team in case they would like to remove the tumor sooner given the new symptomatology.