Thymoma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]Ahmad Al Maradni, M.D. [3]

Overview

Patients with thymoma usually appear asymptomatic. Physical examination of patients with thymoma is may be remarkable for neck lump, facial swelling and wheezing.

Physical Examination

The physical examination plays a limited role in the diagnosis of thymoma; however, it is very important to check general signs for associated diseases.

Appearance of the Patient

• Patient usually appears well and asymptomatic

Skin

• Malar rash may present (suggestive of systemic lupus erythrematouses)

Head and Neck

• Facial swelling may be present
• Neck lump may be present

Chest

• Dullness to percussion on the anterior chest

Lungs

• Wheezing may be present

Musculoskeletal

• Muscle weakness may be present (suggestive of myasthenia gravis)
• Joint deformity may be present (suggestive of an associated joint disease)

Physical examination of myasthenia gravis (observed in 15% of patients with thymoma) A thorough examination demonstrates easy fatigability during the following movements:

• Looking upward and sidewards for 30 seconds: ptosis and diplopia.
• Looking at the feet while lying on the back for 60 seconds
• Keeping the arms stretched forward for 60 seconds
• 10 Deep knee bends
• Walking 30 steps on both the toes and the heels
• 5 Sit-ups, lying down and sitting up completely