Last reviewed: 25 Oct 2020
Last updated: 06 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • myasthenia gravis
  • muscle weakness
  • facial and upper extremity oedema
  • facial plethora
  • distended veins in the neck, chest, and/or abdominal wall
  • left-arm swelling

Other diagnostic factors

  • cough
  • dyspnoea
  • fever and/or weight loss

Risk factors

  • history of myasthenia gravis
  • age >45 years

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • chest CT with intravenous contrast medium
More 1st investigations to order

Investigations to consider

  • chest MRI
  • tissue biopsy
  • acetylcholine receptor antibodies
  • FBC
More investigations to consider

Treatment algorithm

Contributors

Clinical Assistant Professor of Cardiothoracic Surgery

Division of Thoracic Surgery

Stanford University School of Medicine

Stanford

CA

Disclosures

DZL declares that he has no competing interests.

Professor of Cardiothoracic Surgery

Chief, Division of Thoracic Surgery

Medical Director, Thoracic Oncology CCP

Stanford University School of Medicine / Stanford Cancer Institute

Stanford

CA

Disclosures

JBS declares that he has no competing interests.

Dr Douglas Z. Liou and Dr Joseph B. Shrager would like to gratefully acknowledge Dr Tracey Evans, Dr Nicholas Choong, Dr Mario Gasparri, and Dr Cameron Wright, previous contributors to this topic.

Disclosures

TE has received consultancy fees from Genentech and Celgene. She is a board member of Wissahickon Hospice. Educational events include an annual thoracic educational series sponsored by Imedex. NC and MG declare that they have no competing interests. CW is an author of a number of references cited in this topic.

Peer reviewersVIEW ALL

Professor of Surgery

Division of Cardiothoracic Surgery

Department of Surgery

Indiana University School of Medicine

Indianapolis

IN

Disclosures

KK declares that he has no competing interests.

Assistant Attending Surgeon

Thoracic Service

Memorial Sloan-Kettering Cancer Center

New York

NY

Disclosures

JH is an author of a number of references cited in this topic.

Associate Professor

Thoracic Surgery

University of Torino

Torino

Italy

Disclosures

ER is an author of a reference cited in this topic.

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