{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:41Z","timestamp":1753876181763,"version":"3.41.2"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T00:00:00Z","timestamp":1633996800000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute pericarditis as a sign of mediastinal mass is rare and aetiological diagnosis can be challenging without adequate imaging.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>An 18-year-old woman came to our attention describing acute sharp chest pain radiated to the left arm, exacerbated with supine positioning and attenuated while sitting or leaning forward. The electrocardiogram showed diffuse ST elevation and PR depression, with sinus tachycardia. Cardiac biomarkers and D-dimer were negative; echocardiography showed no abnormalities and the absence of pericardial effusion. Her blood work revealed no sign of inflammation or bacterial infection (PCR and procalcitonin were normal); thyroid-stimulating hormone plasma levels were suppressed, showing decompensated thyrotoxicosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Epstein\u2013Barr virus, human immunodeficiency virus, hepatitis C virus, Enterovirus, Parvovirus B19, and Adenovirus tests were normal. Her past medical history was silent, apart from Grave\u2019s disease on treatment with methimazole. Chest computed tomography (CT) was performed and showed the presence of slightly increased density pericardial effusion, with a maximum thickness of 15 mm in the upper mediastinum. Finally, cardiac magnetic resonance (MR) identified a mass of 73 \u00d7 51 mm located in the upper mediastinum. The mass was subsequently biopsed with video-assisted thoracoscopic surgery and the histological analysis showed thymic hyperplasia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case shows the importance of an adequate clinical suspicion of thymic hyperplasia in the context of acute pericarditis symptoms and known Graves\u2019 disease. In this case, a negative chest CT finding may not be sufficient to rule out the diagnosis and cardiac MR imaging is necessary.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab392","type":"journal-article","created":{"date-parts":[[2021,10,12]],"date-time":"2021-10-12T13:32:54Z","timestamp":1634045574000},"source":"Crossref","is-referenced-by-count":3,"title":["Acute pericarditis, Graves\u2019 disease, and thymic hyperplasia: a case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5042-7999","authenticated-orcid":false,"given":"Mauro","family":"Acquaro","sequence":"first","affiliation":[{"name":"Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-742X","authenticated-orcid":false,"given":"Federico","family":"Breviario","sequence":"additional","affiliation":[{"name":"Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Greco","sequence":"additional","affiliation":[{"name":"Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1858-1152","authenticated-orcid":false,"given":"Stefano","family":"Ghio","sequence":"additional","affiliation":[{"name":"Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,12]]},"reference":[{"key":"2021102005233795300_ytab392-B1","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/eurheartj\/ehv318","article-title":"2015 ESC Guidelines for the diagnosis and management of pericardial diseases","volume":"36","author":"Adler","year":"2015","journal-title":"Eur Heart J"},{"key":"2021102005233795300_ytab392-B2","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s11936-018-0654-7","article-title":"Pericardial disease in cancer patients","volume":"20","author":"Ghosh","year":"2018","journal-title":"Curr Treat Options Cardiovasc Med"},{"key":"2021102005233795300_ytab392-B3","doi-asserted-by":"crossref","first-page":"865","DOI":"10.7205\/MILMED-D-12-00531","article-title":"Pericarditis, thymic hyperplasia, and Graves\u2019 thyrotoxicosis: case report and review of the literature","volume":"178","author":"Airel","year":"2013","journal-title":"Mil Med"},{"key":"2021102005233795300_ytab392-B4","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1089\/thy.2017.0086","article-title":"Thymic hyperplasia associated with Graves\u2019 disease: pathophysiology and proposed management algorithm","volume":"27","author":"Haider","year":"2017","journal-title":"Thyroid"},{"key":"2021102005233795300_ytab392-B5","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1210\/jcem-62-3-474","article-title":"Thyroid function modulates thymic endocrine activity","volume":"62","author":"Fabris","year":"1986","journal-title":"J Clin Endocrinol Metab"},{"key":"2021102005233795300_ytab392-B6","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1172\/JCI119032","article-title":"Thymic hyperplasia in patients with Graves\u2019 disease: Identification of thyrotropin receptors in human thymus","volume":"98","author":"Murakami","year":"1996","journal-title":"J Clin Invest"},{"key":"2021102005233795300_ytab392-B7","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/S0025-6196(11)62220-9","article-title":"Thymic hyperplasia presenting as anterior mediastinal mass in 2 patients with Graves\u2019 disease","volume":"77","author":"Budavari","year":"2002","journal-title":"Mayo Clin Proc"},{"key":"2021102005233795300_ytab392-B8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1148\/radiology.142.1.7053522","article-title":"Computed tomography of the abnormal thymus","volume":"142","author":"Baron","year":"1982","journal-title":"Radiology"},{"key":"2021102005233795300_ytab392-B9","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1148\/radiology.142.1.7053521","article-title":"Computed tomography of the normal thymus","volume":"142","author":"Baron","year":"1982","journal-title":"Radiology"}],"container-title":["European Heart Journal - 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