A case of spontaneous thymic hemorrhage

Abstract

A 50-year-old man was admitted to our emergency room due to sudden-onset chest pain. Enhanced CT revealed left-sided pleural effusion, indentified as hemothorax by thoracentesis, showing a 7×5-cm mass-like lesion with extravasation of contrast media in the anterior mediastinum and isodense regions around the lesion. Because of the suspicion of a ruptured mediastinal tumor, we performed a median sternotomy. The thymic parenchyma was distended due to the hemorrhage. A total of 2,170 grams of clotted blood was evacuated from the anterior mediastinum and left pleural cavity. We performed thymectomy. Both gross pathological and histological findings revealed a swollen hematomatous thymus without a neoplastic lesion. There were no abnormal findings on a chest radiograph obtained 2 months before the operation. Therefore, we diagnosed him with spontaneous thymic hemorrhage. To our knowledge, only three adult cases have been reported.