Thymoma (Anterior Mediastinal Mass)

Sivagami*

Assistant Nursing Superintendent, Nursing Department, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Abstract

A patient diagnosed with an anterior mediastinal mass (Thymoma) who underwent VATS-assisted Thymic tumour excision, later converted to open median sternotomy. The report highlights clinical presentation, investigations, surgical management, post-operative ICU care, nursing management, and patient outcome.

Key words: Thymoma; Dyspnea; Anterior mediastinal mass

Introduction

  • Thymoma is a rare tumour arising from the Thymic epithelium.
  • Commonly located in the anterior mediastinum.
  • Often associated with respiratory symptoms and incidental radiological findings.
  • Surgical excision is the mainstay of treatment.

Case presentation

  • Age/Sex: 55Years/Male
  • Chief compliant: Dyspnea on exertion for past 30 days, cough with expectoration past 30 days Known case of type 2 diabetes mellitus / systemic hypertension x 4 years on medication.
  • Known case of left CVA x 3 years ago.
  • History of Spinal surgery x 10 years ago.

Relevant clinical finding:

  • Dyspnea on exertion for past 30 days, cough with expectoration past 30 days.

Relevant Investigation: CT chest

  • Relatively well defined large heterogeneously enhancing soft tissue density mass lesion in left upper anterior mediastinum.
  • Imaging features are in favor of Thymoma (for HPE correlation).
  • Diffuse randomly distributed centrilobular nodules in both lung fields with few of them coalescing to from foci of consolidations in posterior & lateral segments of left lower lobe.
  • Imaging features are in favor of co-existing atypical pneumonitis.

Diagnosis

  • Primary Diagnosis: Thymoma.
  • Location: Anterior mediastinal mass.

Radiological Findings

  • Ct chest showed a large, heterogeneously enhancing soft tissue mass in the left anterior mediastinum
  • Features suggestive of thymoma.

Histopathology (HPE): Type AB Thymoma confirmed.

Associated Conditions

  • Atypical Pneumonia.
  • Diabetes mellitus.

Management

  • Pre-operative management.
  • Baseline investigations completed.
  • Ct chest, ECHO- Normal LV function.
  • Sputum culture is positive for Klebsiella pneumoniae.
  • Multidisciplinary evaluation (Pulmonology, Cardiology, CTVS, Anesthesia).

Surgical Management

  • Video -Assisted Thoracic Surgery- assisted thymic tumor excision with thymectomy.
  • Converted to open median sternotomy due to dense adhesions.
  • Complete excision of mediastinal mass.
  • Bilateral pleural drains placed.
  • Hemostasis secured and sternum closed with stainless steel wires.

Post-operative /ICU Management

  • Oxygen therapy with gradual tapering.
  • ABG monitoring (Initial metabolic acidosis corrected).
  • Chest drains monitoring.
  • Blood sugar monitoring with insulin infusion.
  • Incentive spirometry and breathing exercises.
  • Pain management and infection prevention.

Outcome

  • Patients remained hemodynamically stable.
  • Oxygen requirement gradually reduced and stopped.
  • Chest drains output minimal and drains removed.
  • No post-operative fever or complications.
  • Patient shifted from ICU to ward and recovered well.
  • Spo2 is maintained on room air.
  • Surgical outcome satisfactory.

Discharge

  • Discharged in stable condition.
  • Medications prescribed (antibiotics, analgesics, gastric protection).
  • Advised wound care and hygiene.
  • Continue breathing exercises and incentive spirometry.
  • Avoid heavy lifting and strenuous activities for several weeks.
  • Monitor for warning signs: breathlessness, chest pain, fever.
  • Follow up visit with chest X ray as advised Review scheduled after 5 days.

Conclusion

This case highlights the importance of early diagnosis and comprehensive management of thymoma. Complete surgical excision combined with vigilant post-operative monitoring resulted in a favourable clinical outcome. Multidisciplinary collaboration and evidence-based nursing interventions were instrumental in preventing complications and promoting recovery. Structured nursing care and patient education remain vital components in achieving optimal surgical outcomes and improving quality of life.

 

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