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Unusual Presentation of a Fleshy Mass in the Suprasternal Notch

Author(s): Tarik Ibrahem Ali | Nazar M.T.Jawhar

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 210;
Date: 2011;
Original page

Keywords: Thymus gland | teratoma | anterior mediastinum | suprasternal notch | retrosternal thyroid (goiter)

Introduction: The unusual presentation of this case was the strange and alarming appearance of the pinkfleshy mass, which protruded from underneath the skin at the suprasternal region. This case illustratesthat a cervical swelling can originate from superior mediastinum structures like the thymus gland.Method: A 17 year old boy was presented at clinic with a pink fleshy mass, protruding from underneaththe skin at the suprasternal region. He had previously undergone two operations, which had beenperformed in a district hospital, the first eight months and the second two months previously.Seven days after the second operation, the patient noticed the appearance of a pink coloured mass, whichwas protruding from the surgical wound site of the second operation.The CT scan of the chest and neck showed an anterior mediastinal mass within the thymus gland, whichwas connected to the mass in the neck.A diagnosis of a thymic tumour was made and a thoracotomy operation performed through a mediansternotomy, with the complete removal of the thymus gland and the mass connected to it.Result: Histopathology of the specimen proved that the two solid tumor masses in the right and leftthymic lobes, together with another mass connected to the isthmus of the gland by stalk, were all in fact amature teratoma.Conclusion: This case illustrate that not every cervical swelling with a retrosternal extension will bethyroidal or cervical in origin, but that a mediastinal mass such as the one in our case, could also presentitself as a cervical swelling. This also demonstrates that a cervical swelling should always be takenseriously and full and complete investigations should be carried out by an experienced surgeon in a wellequipped hospital.
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