[Mediastinal chloroma with right heart involvement. Unusual cause of a superior vena cava syndrome].
For four months a 28-year-old man had been suffering from a sensation of pressure in his head when lying down, swelling of the face, exertional dyspnoea and weight gain of 9 kg. Biochemical tests and chest radiograph were unremarkable. Echocardiography revealed a 3 x 5 cm mass in the right atrium, extending into the superior vena cava whose lumen was narrowed to a few millimetres. Computed tomography and magnetic resonance imaging were suggestive of a malignant tumour. Bone marrow biopsy as well as transvascular and mediastinoscopically obtained biopsies failed to provide a pathological diagnosis. Exploratory thoracotomy uncovered a nonresectable chloroma surrounding both venae cavae. It had penetrated into the right and left atria, as well as the pulmonary veins. A Gore-tex bypass was placed between the innominate vein and right atrial appendage. The tumour was identified as a local manifestation of acute myeloid leukaemia. Treatment with idarubicin (12 mg/m2 daily for 3 days) and adriamycin (1.5 mg/m2 daily for 4 days) followed by radiotherapy with 35 Gy achieved partial remission and 15 months after onset of treatment the patient is in a good general condition.
Völler
H
H
Abteilung für Kardiologie/Pulmonologie, Universitätsklinikum Steglitz, Berlin.
Dingerkus
H
H
Albrecht
A
A
Hennig
L
L
Stein
H
H
Schröder
R
R
D000328:Adult; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007951:Leukemia, Myeloid / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D009361:Neoplasm Invasiveness; D013479:Superior Vena Cava Syndrome / Q000209:etiology*
Mediastinal-Chlorom mit Rechtsherzbeteiligung. Seltene Ursache eines Vena-cava-superior-Syndroms.