Thymic Carcinoma Invading Bilateral Internal Thoracic Artery Bypass Grafts

Thymic carcinoma, a rare but aggressively growing malignancy that tends to invade nearby structures, requires early intervention and is often associated with poor prognosis. A 73-year-old man presented with vague chest pain. Imaging studies coincidently revealed an anterior mediastinal mass invading bilateral internal thoracic artery bypass grafts. Angiography showed diffuse stenosis due to tumor compression and numerous feeding arteries. Positron emission tomography scans led to the clinical diagnosis of thymic carcinoma, stage IVb. We reported an extremely rare and complicated case of unresectable thymic carcinoma invading coronary artery bypass grafts, aiming to discuss the complex features challenging the diagnostic approach and management of the disease. Diffuse stenosis on angiography may suggest extravascular compression by coincident mediastinal tumors. Complicated cases of mediastinal neoplasm with invasion of vital structures require individualized diagnostic approaches and treatment strategies.