Chest Pain and Shortness of Breath in a 59-Year-Old Man
BACKGROUND
A 59-year-old man presents to the emergency department (ED) with a 6-month history of progressive shortness of breath as well as new onset of mild chest pain. He has no history of fever, chills, coughing, hemoptysis, weight loss, or smoking. He is otherwise healthy and does not take any medications on a regular basis.
On physical examination, the patient is afebrile, with normal vital signs, including an oxygen saturation rate of 99% while breathing room air. He does not appear to be in acute distress. The cardiovascular examination reveals conjunctival pallor. No evidence of muscle weakness or neurologic deficit is noted. Routine laboratory studies reveal a white blood cell (WBC) count of 7200/µL, a hemoglobin level of 10.1 g/dL (101 g/L), a hematocrit of 36% (0.36), and a platelet count of 120,000/µL (120 × 109/L).
Routine posteroanterior (PA) and lateral chest radiographs are obtained, and a computed tomography (CT) scan is ordered.
What is the diagnosis?
HINT
Note the large, lobulated, noncalcified soft-tissue mass in the anterior mediastinum in this older patient who presents with mild chest pain and dyspnea.
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