When Constriction Is Not Just the Pericardium: Extrinsic Cardiac Encasement by Thymic Squamous Cell Carcinoma

Figures

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  Figure 1. Transthoracic echocardiographic assessment of ventricular interdependence Transthoracic echocardiography illustrates the hallmark hemodynamic findings of constrictive physiology. Panel A: Pulsed-wave Doppler of transmitral inflow shows a significant reduction in velocity during inspiration (single red arrow) and a reciprocal increase during expiration (double red arrows). Panel B: Pulsed-wave Doppler of transtricuspid inflow demonstrates a reduction in velocity during expiration (single red arrow) and a marked increase during inspiration (double red arrows). Panel C: The apical four-chamber view identifies the interventricular septum (single green arrow) with a prominent "septal bounce" (triple green arrows), diagnostic of reciprocal filling within a fixed, non-compliant cardiac volume.

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  Figure 2. Posteroanterior (PA) erect chest radiograph The PA chest X-ray demonstrates significant opacification of the right hemithorax, indicative of the primary mediastinal mass. The left lung remains clear without evidence of consolidation, though a mild left-sided pleural effusion is present. The single green arrow identifies the metallic stent within the superior vena cava (SVC), previously placed to manage radiation-induced fibrosis. The double green arrows highlight the left-sided pleural effusion, and the triple green arrows delineate the extensive right-sided mass responsible for the hemithorax opacification and extrinsic cardiac encasement.

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  Figure 3. Contrast-enhanced chest computed tomography (CT) Axial contrast-enhanced CT images at the level of the great vessels (A) and upper cardiac chambers (B) demonstrate significant disease progression and malignant cardiac encasement. The mass directly infiltrates the mediastinal pleura and pericardium, becoming inseparable from the adjacent epicardial fat pads. Panel A: The single green arrow identifies the pulmonary artery and its primary branches. Double green arrows highlight the enhancing malignant soft tissue in the right anterior mediastinum. Triple green arrows demonstrate the paravertebral soft tissue involvement adjacent to the thoracic spine, encroaching upon the adjacent right-sided neuroforamina and intercostal musculature. Panel B: The single green arrow points to a moderate pericardial effusion within the "rigid shell." The double green arrows identify the right-sided anterior mediastinal soft tissue. The triple green arrows delineate the diffuse, nodular enhancing pleural thickening along the right lung, as well as the paraspinal mass responsible for the extrinsic compression of the inferior vena cava (IVC) and deformity of the right atrium (RA).