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Unusual presentation of more common disease/injury
Case report
STEMI: rare initial presentation of a mediastinal mass supplied by the RCA
  1. Benjamin B Claxton,
  2. Justin Loloi,
  3. Oliver D Mrowczynski and
  4. Muhammad Abdulbasit
  1. Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
  1. Correspondence to Benjamin B Claxton; bclaxton20{at}gmail.com

Abstract

In the setting of severe septic shock, a 70-year-old woman had an ST segment myocardial infarction with ST elevations in the inferolateral leads. On cardiac catheterisation, no obstructive pathology was noted. Chest imaging revealed a large mediastinal mass measuring 8.5×6.5×7.5 cm in the visceral compartment of the mediastinum, with contrast enhancement from the right coronary artery (RCA). A biopsy was preformed and cytology was consistent with a well-differentiated neuroendocrine neoplasm. On review of the cardiac catherisation, it was noted that the mass was deriving blood supply from the RCA. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare but well-documented phenomenon. In this case, MINOCA was caused by coronary steal syndrome in the setting of profound hypotension. Immediate management is with haemodynamic support; there is no role for coronary intervention.

  • arrhythmias
  • clinical diagnostic tests
  • adult intensive care

https://doi.org/10.1136/bcr-2019-231880

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    Footnotes

    • Contributors All authors have had substantial contributions to the conception and design of the paper submitted herein. All authors have been involved in drafting the work and revising it critically for important intellectual content. All authors approve of the final version published. BBC: analysis of data and preparation of the manuscript, conception and design. MA: identification of case for write-up, conception and design. JL: contribution with research on myocardial infarction with non-obstructive coronary arteries and coronary steal, in addition to review and editing. OM: image processing, preparation of the manuscript, review and editing

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.