MEDIASTINAL MASS-INDUCED T WAVE INVERSION: FROM A ROUTINE EKG TO A MEDIASTINAL MASS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: T-wave inversion (TWI) is a negative of ≥1 mm in depth two or more contiguous leads, with exclusion leads aVR, III, and V1[1]. TWI has wide differential diagnosis that can range from benign causes including normal variants to life-threatening coronary artery disease rarely be related non-cardiac [1]. CASE PRESENTATION: Our patient an 18-years-old female past medical history asthma major depressive disorder. She presented the psych emergency department (ED) because suicidal attempts. Patient complaints worsening feelings sadness, loss interest, decreased energy. Also, she reported having ideations. Review systems was unremarkable vitally stable. On physical examinations, lungs were clear auscultation, cardiovascular exam heart sounds, no murmurs gallops. Labs within limits, electrolytes, TSH, D-Dimer, cardiac enzymes. The routine evaluation protocol ED includes Electrocardiogram (EKG) mainly look for QTC intervals, as many medications are used population may alter interval. Her EKG showed sinus rhythm T wave II, aVF, V3-V6 QTc 483; there previous EKGs comparison. repeated on different days same findings. family diseases. Cardiology consulted, echocardiogram large extracardiac mediastinal mass which appears press right ventricle; otherwise, ejection fraction normal, significant valvular observed. A computerized tomography scan chest revealed large, 12 x 7 6 cm along inferior wall heart, exerting effect displacing superiorly. discharged referred cardiothoracic surgeon further evaluation. DISCUSSION: Different clinical conditions cause inversions, ranging events, such acute ischemia pulmonary embolism, entirely conditions[1]. mediastinum potential space thoracic cavity subdivided into anterior, middle, posterior, superior form lesion [2]. In our case, Inferolateral investigated found have middle could pericardial cyst, bronchogenic esophageal implications cyst lymph node enlargement secondary tuberculosis sarcoidosis histoplasmosis. CONCLUSIONS: This case highlights inferolateral should always thoroughly, by imaging studies when not prevent life threatening conditions. REFERENCE #1: Hayden GE, Brady WJ, Perron AD, Somers MP, Mattu A. Electrocardiographic inversion: pain patient. Am J Emerg Med. 2002 May;20(3):252-62. doi: 10.1053/ajem.2002.32629. PMID: 11992349. #2: Mediastinum. In: Gurney JW, Winer-Muram HT, Stern EJ, et al, editors. Diagnostic imaging: chest. Section I. Salt Lake City (Utah): Amirsys; 2006 DISCLOSURES: No relevant relationships Hasan Abuamsha, source=Web Response Abdul Rahman Al Armashi, Isaac Alsallamin, Ameed Bawwab, Eleonora Demyda, Faris Hammad,