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

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

Apperance

• Patient usually appears well and asymptomatic

=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 autoimmune disease)

Skin

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

Physical examination of myasthenia gravis (associated with 15% of patients with thymoma) Shows muscle fatigability and can be tested for many muscles.

A thorough examination demonstrates easy fatigability during 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