Acute presentation of thymoma with infarction or hemorrhage

The presentation of thymomas is variable; most are asymptomatic and others present with local compression symptoms or a parathymic syndrome. Rarely thymomas present as an acute emergency with severe chest pain from either infarction or hemorrhage of the tumor. This rare presentation usually leads the clinician initially away from the diagnosis of thymoma. We present 4 patients who presented with infarction (3 patients) and hemorrhage (1 patient) who were initially believed to have a lymphoma. Preoperative biopsies were unrevealing. All had a complete resection and were in the early Masaoka stage. There have been no recurrences in follow-up. The astute clinician should be aware of this unusual presentation. The prognosis seems to be good in patients who present with infarction or hemorrhage.