ABSTRACT
Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial effusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non-productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericarditis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient's condition deteriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymic pathologies should be included as a rare etiology in the differential diagnosis of purulent pericardial effusion.
ABSTRACT
Purpose: Distinguishing between high-grade and low-grade meningiomas might be difficult but has high clinical value in deciding precise treatment and prognostic factors. Magnetic resonance imaging (MRI) using apparent diffusion coefficient (ADC) values and dynamic contrast enhancement (DCE) may have a significant role in capturing such complexities. Methods: Data from our hospital database on meningioma patients from January 2020 to December 2021 were obtained. The MRI results of all patients were evaluated for mean ADC value and DCE parameters, including time-signal intensity curves (TIC), maximum signal intensity (SImax), time to maximum signal intensity (Tmax), maximum contrast enhancement ratio (MCER), and slope. Results: In this retrospective analysis, 33 individuals were included. Twenty-eight (84.8%) patients were pathologically diagnosed with low-grade meningioma and five (15.2%) patients with high-grade meningioma. There is a crossover between high- and low-grade meningiomas in conventional MRI. Tumor size, location, shape, necrotic/cystic changes, peritumoral edema, and enhancement patterns did not differ substantially between groups (p = 0.39, 0.23, 0.28, 0.57, 0.56, and 0.33, respectively). The mean ADC and Tmax values of high-grade meningiomas were substantially lower than those of low-grade meningiomas (p = 0.002 and 0.02, respectively). An optimal cut-off of 0.87 × 10-3 mm2s-1 for the mean ADC value (area under the curve [AUC] = 0.94, sensitivity = 80%, specificity = 92.8%) and 42 s for Tmax (AUC = 0.84, sensitivity = 80%, specificity = 89.3%) was suggested. High-grade meningiomas had significantly higher TIC, SImax, MCER, and slope than low-grade meningiomas (p = 0.004, < 0.001, 0.01, and 0.001, respectively). Type IV TIC had a sensitivity of 80% and specificity of 89.3% in distinguishing high-grade meningiomas from low-grade meningiomas. Optimal cut-offs of 940.2 for SImax (AUC = 0.98, sensitivity = 80%, specificity = 96.4%), 245% for MCER (AUC = 0.94, sensitivity = 80%, specificity = 85.7%), and 5% per second for slope (AUC = 0.97, sensitivity = 80%, specificity = 96.4%) were estimated. Conclusion: The ADC value and DCE-MRI parameters (TIC, SImax, Tmax, MCER, and slope) are potential predictors for separating high-grade from low-grade meningiomas.
