Anterior Mediastinal Mass and Pericardial Effusion With Right Ventricular Outflow Tract Obstruction Secondary to Dual Compression.

backgroundAnterior mediastinal masses frequently manifest with pericardial effusion and compressive symptoms, creating management challenges due to the risk of cardiovascular collapse during intervention. CASE SUMMARY: Two patients with primary mediastinal B-cell lymphoma presented with large pericardial effusions and right ventricular outflow tract obstruction. The first patient was successfully managed with tumor-directed therapy alone. The second patient underwent emergency surgery following failed pericardiocentesis, resulting in cardiac arrest requiring mechanical circulatory support. DISCUSSION: These 2 cases highlight the critical decision making required when managing anterior mediastinal masses with pericardial effusion. Whereas guidelines typically recommend urgent drainage for significant effusions with tamponade physiology, this approach may be detrimental in the presence of anterior mediastinal masses. TAKE-HOME MESSAGES: Emergency pericardiocentesis in the setting of malignant anterior mediastinal mass may confer greater risk than benefit. Systemic antineoplastic therapy is encouraged as first-line treatment to promote tumor reduction and mitigate compressive symptoms.