Solitary Fibrous Tumor Presenting as Mediastinal Tumor Receiving Blood Supply from Left Internal Thoracic Artery Graft of Coronary Artery Bypass Grafting: A Case Report.

introductionA solitary fibrous tumor (SFT) in the thorax typically originates from the visceral pleura, and its presentation as a mediastinal tumor is rare. We report a case of an SFT presenting as a mediastinal tumor with a history of coronary arterial bypass grafting (CABG), in which the left internal thoracic artery (LITA) graft was anastomosed to the left anterior descending artery (LAD), and the LITA graft provided blood flow to the tumor. CASE PRESENTATION: A man in his 30s was referred to our department for the diagnosis and treatment of an anterior mediastinal mass. He had a history of CABG during childhood, in which the LITA graft was anastomosed to the LAD for a complication of the coronary artery of Kawasaki disease. The tumor was a well-defined anterior mediastinal mass measuring 8.7 cm in size, which was adjacent to the ascending aorta and chest wall but did not show invasiveness. A thymoma or low-grade mediastinal tumor was highly suspected on imaging. Evaluation of the coronary arteries and the graft demonstrated that the LITA graft provided a large amount of blood flow to the tumor, and the right coronary artery provided collateral flow to the LAD area. It is acceptable for the LITA graft to be sacrificed during surgery because of this collateral flow. Surgical resection via re-sternotomy and anterolateral left thoracotomy was performed. The tumor was successfully dissected from the surrounding tissue, and the pedicle of the tumor was recognized at the left upper lobe of the lung. Pathologically, the tumor was diagnosed as SFT without aggressive characteristics.

conclusionsSFT presenting as a mediastinal tumor is rare, and impressive imaging of blood supply from the CABG graft was observed. Detailed coronary imaging contributed to the surgical strategy.