A teenager with recurrent supraventricular tachycardia and a giant mediastinal mass
| Autor: | Keren Hasbani, Diego Ramonfaur, Michael D. Josephs, Daniel Shmorhun |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Holter monitor Cystic teratoma lcsh:Surgery Pediatric surgery 03 medical and health sciences 0302 clinical medicine medicine Palpitations cardiovascular diseases Endocardium Past medical history medicine.diagnostic_test business.industry Teratoma lcsh:RJ1-570 Supraventricular Tachycardia Mediastinum lcsh:Pediatrics lcsh:RD1-811 medicine.disease medicine.anatomical_structure 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health cardiovascular system 030211 gastroenterology & hepatology Surgery Radiology Supraventricular tachycardia medicine.symptom business |
| Zdroj: | Journal of Pediatric Surgery Case Reports, Vol 64, Iss, Pp 101750-(2021) |
| ISSN: | 2213-5766 |
| DOI: | 10.1016/j.epsc.2020.101750 |
| Popis: | We describe a unique case of a teenager with past medical history of anxiety, dysmenorrhea and a one year of recurrent symptomatic palpitations who was found to have an exceptionally large mediastinal teratoma which was compressing the right atrium, after evaluation for recurrent symptomatic supraventricular tachycardia. Our case adds new perspectives on the evaluation of what may seem to be an indolent arrhythmia. Her symptoms were initially thought to be secondary to her treatment with fluoxetine and oral combined contraceptives, which were discontinued but her symptoms persisted. A follow-up 12-lead electrocardiogram revealed normal sinus rhythm for which a 48-h Holter monitor was placed and yielded multiple episodes of overt AV node reentrant supraventricular tachycardia (SVT). She was referred to our center for evaluation for ablation for which she underwent routine pre-ablation echocardiography and was found to have an exceptionally large mediastinal mass consistent with a cystic teratoma significantly compressing the right atrium causing partial obstruction of the tricuspid annulus. The mass was successfully excised, and the pathology report revealed a 16cm cystic teratoma arising from thymic tissue. The mediastinum is the second commonest site to find a teratoma. These are congenital masses thought to arise from a defect in embryonal cell migration and by definition include all three embryonal cell layers, thus potentially may differentiate any kind of tissue. We emphasize the importance of pre-ablation imaging studies to evaluate for secondary causes of SVT, as catheter manipulation of the endocardium could have resulted in devastating consequences such as atrial rupture. |
| Databáze: | OpenAIRE |
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