Massive thymic hemorrhage and hemothorax occurring in utero

Abstract

Background: Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality.

Case presentation: We report a case of spontaneous massive thymic haemorrhage in a newborn developing at birth acute respiratory distress associated with severe bilateral haemothorax. Thymic enlargement was evident after pleural evacuation and confirmed by radiographic, Computed Tomography (CT) images and Magnetic Resonance Imaging (MRI) sequences. The spontaneous resolution of this enlargement seen with CT scan and MRI sequences suggested a thymic haemorrhage; surgery was not necessary.

Conclusion: Thymic haemorrhage should be considered in newborn infants with pleural effusion, mediastinal space enlargement and Respiratory Distress.

Fig. 1

Chest X-ray on day 3: pleural effusion resolution; relevant mediastinum enlargement

Fig. 2

MR-sequences on day 16: thymus occupies the antero-superior mediastinum, with greatly reduced dimensions compared to the previous CT scan. Thymus appears to be homogeneous and with hyperintense signal in T1 as in T2 sequences. This aspect is suggestive of a recent bleeding. (Intera 1,5 T- Philps)