A 61-year-old male was presented with shortness of breath, and there was a mediastinal enlargement in the chest radiography. Thorax computed tomography (CT) showed an anterior mediastinal mass with 18×10×12 cm size that pushed the heart and main vascular structures posteriorly (Fig. 1). Positron emission tomography showed an increased fluorodeoxyglucose uptake. Therefore, a biopsy was performed, which proved that thymoma Type B2 is present. Although external mild right pulmonary artery (RPA) compression was observed on CT, transthoracic echocardiography (TTE) did not show a significant gradient. After 9 months, the patient presented with increased dyspnea and chest pain. The admission CT showed increased diameters of thymoma (19×12×15 cm), with severe compression on the left atrium (LA) and RPA (Fig. 2). TTE showed an anteriorly located mass image in the parasternal view that pushed the heart posteriorly (Fig. 3a), LA compression in the apical views (Fig. 3b and 3c), and moderate pulmonary stenosis with 48 mm Hg maximum gradient in the subcostal view, as parasternal short axis view was poor (Fig. 3d). Surgical excision was planned after chemotherapy by the multidisciplinary team.
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