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Case Reports
. 2020 Oct 30:4:32.
doi: 10.21037/acr-19-174. eCollection 2020.

Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report

Clara Salles Figueiredo  1 , Isabela Bispo Santos da Silva Costa  1   2   3 , Cristina Salvadori Bittar  1   2   3 , Antonio Fernando Lins de Paiva  2 , Ivanhoé Stuart Lima  1 , Paulo Henrique do Amor Divino  1 , Carolina Maria P D de C Silva  1 , Silvia Moulin Ribeiro Fonseca  1 , Roberto Kalil Filho  2   3 , Ludhmila Abrahão Hajjar  1   2
Affiliations
Case Reports

Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report

Clara Salles Figueiredo et al. AME Case Rep. .

Abstract

Thymomas are usually tumors with a good prognosis but with potential to invade nearby structures. We report a case of a 56-year-old woman previously diagnosed with an invasive thymoma that came to the emergence room with symptoms of acute coronary syndrome. After a coronary computed tomography angiography, it was seen that the tumor was invading the myocardial and it was irrigated by the left circumflex coronary and its branches. Considering her poor prognosis, it was decided not to make further interventions. This case highlights a unique and rare case of an unresectable thymoma that was invading the myocardium and it was irrigated by the left circumflex coronary and its branches, causing typical angina due to compromised coronary blood flow by the mass causing ischemia.

Keywords: Thymoma; acute coronary syndrome; case report; neovascularization.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/acr-19-174). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Cardiac magnetic resonance imaging (MRI) showing the thymoma invading the left ventricle. (A) Cine MRI 2 chamber; (B) cine MRI 4 chamber; (C,D) cine MRI short axis; (E,F) late gadolinium enhancement showing an heterogeneous contrast captation.
Figure 2
Figure 2
Timeline of the patient with a thymoma B2 Masaoka IV.
Figure 3
Figure 3
Initial electrocardiogram.
Figure 4
Figure 4
Coronary artery angiotomography showing thymoma and its relationship with the heart. (A,B) CCTA images show the macroscopic neovascularization of the thymoma irrigated by the left circumflex artery and its branches. (C,D) CCTA images demonstrate the invasion of the myocardium by the tumor. CCTA, coronary computed tomography angiography.
See this image and copyright information in PMC

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