Dyspnea and Night Sweats in a 46-Year-Old Man

Roza Chaireti, MD; Mats Pettersson, MD


January 15, 2020

Laboratory Test Results and Other Findings

Significant laboratory findings include a white blood cell count of 9.1 x 103/µL (9.1 x 109/L; reference range, 3.5-8.8 x 109/L), a platelet count of 429 x 103/μL (429 x 109/L; reference range, 140-350 109/L), a C-reactive protein level of 91 mg/L (reference range, < 10 mg/L), a lactate dehydrogenase (LDH) level of 4.7 microkatals (µkat)/L (reference range, < 3.5 µkat/L), an erythrocyte sedimentation rate (ESR) of 30 mm (reference range, 1-12 mm), and a D-dimer of 2.2 mg/L (reference range, < 0.25 mg/L).

A spiral CT scan is performed, which shows no pulmonary embolism. It does, however, reveal the presence of a significant pericardial effusion (1 cm ventral x 2.5 cm dorsal) and a multilobular substernal mass occupying the anterior superior mediastinum that is about 2.5 cm in thickness and 7 cm in length, with high absorption. Additionally, the mediastinal lymph nodes are enlarged; some are as large as 2 cm in size. No other pertinent findings on spiral CT are reported.

An emergent bedside echocardiogram is obtained. The echocardiographic findings confirm the presence of pericardial effusion, without signs or symptoms of a cardiac tamponade; additionally, a retrosternal mass is detected (see video clips).


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