Myasthenia Gravis

Author: Mark Allen, MD
Institution: Mayo Clinic
Date Reviewed: February 2014
Learning Domain: General Thoracic
Learning Objective: Management of Myasthenia patients
PowerPoint File: Myasthenia Gravis

Discussion Points

• Interpretation of Diagnostic tests
  • Review CXT and CT (no thymoma) should always look for one
• Why the “odd” PFT testing
  • Bugle pressures
• Therapeutic options
  • Medication, surgery
• What type of thymectomy to use?
  • Median sternotomy, VATS R or L or both, cervical

Learning Points

• Presenting symptoms and pathophysiology of myasthenia gravis
• Evaluation of mediastinum
• What type of MG patients are helped by thymectomy
  • Better in short sx duration, younger, female and those with thymic hyperplasia on pathology
• Diseases associated with MG – thymoma, pure red cell aplasia, hypogammaglobulinemia, Sorgrens, rheumatoid arthritis, thyroiditis

Outcomes

• Pt underwent thymectomy via median sternotomy
• Benign post operative course
• Discharged routinely with some improvement in symptoms
• Medications: Mestinon
• Pathology:
  • Thymus, thymectomy: True thymic hyperplasia (65.8 g)