Cause for Concern? - Residual or Rebound thymic tissue

[ChicagoSteveT]

Hello - I recently had a heart 64 slice CT scan performed to get my calcium score.  I'm 30 years old and have been experiencing chest pain while resting.  The calcium score came back as 0 which is great, but there were some other comments in the Addendum that I dont fully understand (my doctor said he wasn't too concerned about them).

They are: "There is a trace amount of pericardial effusion. Small amount of nodular soft tissue densities seen within the anterior mediastinum is nonspecific, may be residual or rebound thymic tissue versus other soft tissue origin.  It is incompletely visualized.  Clinical correlation is recommended."

Anyone have insight into what this means or if I should be concerned? The doctors attribute most of my chest pain to anxiety & stress.
Thanks!
Steve

[NurseMomma11]

I too recently had anterior mediastinal tissue that showed up on CT with normal CXR. Also had two nodule in R lung. The two combined may have been nothing to worry about, but could also have been suspicious for tumor. Follow-up CT in 3 months (at a minimum) was recommended to rule out growth of the medistinal mass/ tissue. On the off chance this ended up being a thymic carcinoma or lymphoma, my dr opted for biopsy. The most effective way to get to the areas I had (which would be difficult to get to with CT guided needle biopsy) ended up being a robotic thorocosopy or robotic VATS. I had this done 3 wks ago, and feel great! Wasn't a pain-free surgery, infact was VERY painful, but I'm back to 100% in 3 wks so was worth it to me. I now have peace of mind. All areas of concerned were removed and biopsied. Anterior mediastinal mass was residual (and still active) thymic tissue, which they think could have been causing my autoimmune issues. The two lung nodules were necrotic (dead) lymph nodes. Which are nothing to worry about, but are a rare disorder called Kikushi disease. Could be related to autoimmune disease, blah blah blah. Anyway, I'm off most of my meds, and feel way better than I have in years. Hope you get the answers you need. I would consider seeing rheumatologist if you have autoimmune symptoms and possibly a cardio-thoracic surgeon who does robotic surgery. Good luck to you.

[ChicagoSteveT]

Yeah, that did seem odd to me as well.  I'm going to have another doctor review it I think.  Not exactly sure how something like that could be monitored either, since it's not like I can have this type of CT scan done every month.  Maybe every year, but then I'm guessing my doc is going to think I'm crazy for not believing him and getting all these tests when I'm only 30.  My friend works at one of the Top Heart hospitals in the US so he was going to show the findings to one of the cardio guys there.  

It is worth mentioning that this never came up on a normal chest xray taken only a few weeks earlier.  Maybe that doesnt show as much detail?  Was thinking of getting a PET scan, but doc didnt want to expose me to that much radiation.

[kenkeith]

I agree.  Normally there is some fluid surronding the heart, but for the doctor to list it on the report indicates to me it is something worth mentioning in a medical sense?!.  My CT scan didn't list any effusion!

[ChicagoSteveT]

Yeah, the fact that the report says "Trace amount" of pericardium effusion seems to mean that it's such a small amount that it shouldn't a concern.  Otherwise I'm thinking my cardiologist would have suggested a follow up.  I think a little bit of fluid sounds normal, and the function of my heart has been good for every test I've had.  I'm 30 years old, so this is what should be expected.  It's just odd that they list that on the addendum of a CT scan if it was normal.

[kenkeith]

Worst case scenario for the unexplained image seen with the CT scan could be a tumor.  It seems reasonabe to get a definite diagnoses for the soft tissue growth or lack thereof.  

For some insight on pericardial effusion.  It is the accumulation of excess fluid around the heart. The heart is surrounded by a double-layered, sac-like structure called the pericardium. The space between the layers normally contains a very small amount of fluid.

Pericardial effusion is often related to inflammation of the pericardium due to disease or injury, but pericardial effusion can occur when there is no inflammation. Pericardial effusion can also result from the accumulation of blood after a surgical procedure or injury.

When the volume of fluid exceeds the pericardium's "full" level, pericardial effusion puts pressure on the heart, causing poor heart function. If left untreated, pericardial effusion can cause heart failure or death.

[ChicagoSteveT]

Thanks for the follow up.  No, didn't have any type of Chemo for a mass.  Just had this CT scan done to get a calcium score.  Again, my cardiologist didn't seem concerned, so I'm guessing it's not a big deal, but want to see what others think.  

Others heart related tests I've had are holter monitor (for palpitations), hsCRP blood test, chest x-ray, stress test, tons of EKG's, various other blood tests, renal study (kidneys).  All have come back negative.  

Should I get another opinion?

[kenkeith]

"There is a trace amount of pericardial effusion".

>>>>Indicates some fluid buildup of area between the heart muscle and outer lining (pericardial sac).

"Small amount of nodular soft tissue densities seen within the anterior mediastinum is nonspecific, may be residual or rebound thymic tissue versus other soft tissue origin.  It is incompletely visualized.  Clinical correlation is recommended."

>>>the anterior mediastinum, which is immediately posterior to the sternum and the anterior surface of the pericardium and great vessels (middle of the chest and the location of the thymus gland). Did you have chemo or something for a mass?...it is not clear to the doctor whether there has been a rebound or tissue of other origin. Requires a followup.