Thymic epithelial tumour (TET) is the most common tumour affecting the anterior mediastinum in adults. The cardiac extension is often limited to the pericardium, and intracardiac extension is rare. We present a unique case of encasement and displacement of the left anterior descending coronary artery by the large mediastinal tumour leading to myocardial ischemia. Our patient is a 28-year-old lady with stage 4 TET. She presented with acute chest pain associated with 12-lead ECG changes and a significant rise in serial troponin I. Multimodality cardiac imaging revealed encasement and displacement of the left anterior descending coronary artery by the large mediastinal tumour. CT-FFR demonstrates evidence of ischemia which would account for her acute presentation. Following detailed MDT discussions between cardiologists, oncologists and cardiothoracic surgeons, the decision was made to treat this lady with palliative chemotherapy. Given the extent of the tumour invasion and failure of the initial therapy, her prognosis and the outcome were poor. TET could cause atrial compression, myocardial infiltration, and invasion of the pulmonary and caval veins; however, to the best of our knowledge, this is the first case reported of coronary artery displacement and encasement by TET.

中文翻译：

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胸腺癌伴左前降支外源性闭塞：年轻女性心肌梗死的独特病例


胸腺上皮肿瘤（TET）是影响成人前纵隔的最常见肿瘤。心脏延伸常局限于心包，心内延伸很少见。我们提出了一个独特的病例，即大型纵隔肿瘤包裹和移位左冠状动脉前降支，导致心肌缺血。我们的患者是一位 28 岁的女士，患有 TET 4 期。她出现急性胸痛，伴有 12 导联心电图变化和连续肌钙蛋白 I 显着升高。多模态心脏成像显示左冠状动脉前降支被大纵隔肿瘤包裹和移位。 CT-FFR 显示了缺血的证据，这可以解释她的急性表现。经过心脏病专家、肿瘤专家和心胸外科医生进行详细的 MDT 讨论后，决定对这位女士进行姑息化疗。考虑到肿瘤侵袭的程度和初始治疗的失败，她的预后和结果很差。 TET可引起心房受压、心肌浸润以及肺静脉和腔静脉的侵犯；然而，据我们所知，这是第一例因 TET 导致冠状动脉移位和包绕的病例。