Atypical Chest Pain With a Systolic Murmur

John S. Bomalaski, MD; Gary J. Martin, MD; David J. Mehlman, MD
Arch Intern Med. 1983;143(8):1583-1585. doi:10.1001/archinte.1983.00350080101022.
Text Size: A A A
Published online

A 32-year-old man complained of chest discomfort. He had been well during the preceding months except for retrosternal pain related to anxiety or external chest compression. Sarcoidosis had been diagnosed three years previously on the basis of bilateral hilar lymphadenopathy on chest roentgenogram with abnormal pulmonary function test results. Physical examination was remarkable for left supraclavicular lymphadenopathy, a new 2/6 systolic ejection murmur at the cardiac base, and a two component pericardial friction rub. An echocardiogram (Fig 1) was performed.

What is your diagnosis?

Diagnosis.  —Anterior Mediastinal Mass (Seminoma).Anterior to the aorta at the level of the aortic valve one expects to see an echo-free space representing the right ventricular outflow tract. Instead, the M-mode echocardiogram (Fig 1) shows an area of dense echoes due to a mass anterior to the heart. The extent of the anterior mediastinal mass is better delineated by the two-dimensional echocardiographic views (Fig 2).


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.