A 43-year-old Caucasian female presented to the ED with significant dyspnea, thoracic pain and fever. She presented a negative medical history and no therapy. During the physical examination, the patient was uncomfortable. Her vital signs were: blood pressure, 100/90 mmHg; respiratory rate, 50 breaths/minute; heart rate, 130 beats/minute; and temperature superior of 38°C. Oxygen saturation was 80% on room air and 90% with the aid of oxygen. The abdominal examination was unremarkable. Laboratory evaluation revealed high leukocytosis with a white blood cell (WBC) count of 15 per mm³. Arterial Blood Gases (ABG) demonstrated respiratory acidosis: PO2 80, PCO3 60, KCO3 30 mmEq. Thoracic X-ray revealed a massive plural effusion. Computed tomography demonstrated a giant mediastinal mass surrounding pulmonary artery, aorta and pericardia pleura associated with massive pleural effusion. The patients immediately started intravenous (IV) fluids of 2l in 6 hours, Foley and jugular catheter vein cannulation to support main arterial pressure and urine output. The patient was transferred to surgical services where a 28 Fr thoracic drainage was inserted. Post-drainage thoracic (TC) scan demonstrated only the giant mediastinal mass. FNA CT scan guided was performed. Hystopatological findings were mediastinal lymphoma B-Cells. The patient was discharged three day after.

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Corresponding author
Danilo Coco, Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy (webcostruction@msn.com)