anterior mediastinal mass in the exam
Thymuskarzinom
in der Computertomographie mit Kontrastmittel. Der maligne Charakter wird durch die ummauernde Ausdehnung und unscharfe (infiltrierende!?) Begrenzung deutlich. 1 : Das Karzinom 2 : V. cava superior 3 : Truncus brachiocephalicus 4 : Linke A. subclavia und A. carotis communis 5 : Aortenbogen 6 : Sternum
Malignes
Thymom / Thymuskarzinom in der Computertomographie (axial). Die Histologie erbrachte ein primäres Karzinom des Thymus vom Plattenepithelial-Typ, dem häufigsten Typ des Thymuskarzinoms. Das CT zeigt eine große, nicht scharf begrenzte Formation im vorderem Mediastinum mit Verdrängung der Lunge und Zeichen einer möglichen Infiltration in Nachbarstrukturen. Inhomogene Kontrastierung. Zysten oder Verkalkungen fanden sich in diesem Fall nicht.
Malignes
Thymom / Thymuskarzinom in der Computertomographie (sagittal). Die Histologie erbrachte ein primäres Karzinom des Thymus vom Plattenepithelial-Typ, dem häufigsten Typ des Thymuskarzinoms. Das CT zeigt eine große, nicht scharf begrenzte Formation im vorderem Mediastinum mit Verdrängung der Lunge und Zeichen einer möglichen Infiltration in Nachbarstrukturen. Inhomogene Kontrastierung. Zysten oder Verkalkungen fanden sich in diesem Fall nicht.
Mikronoduläres
Thymom mit lymphoidem Stroma. Hier Computertomographie axial.
Anterior
mediastinal mass consistent with primary mediastinal large B cell lymphoma. Axial chest CT shows an enhancing left anterior mediastinal mass compressing the aortic arch.
Mediastinal
liposarcoma of thymic origin. Axial CECT Thorax shows heterogeneously enhancing soft tissue density mass in the anterior mediastinum with areas of fat (*) displacing the trachea (T) slightly to the right.
Mediastinal
liposarcoma of thymic origin. Coronal CECT showing the mass lesion and pericardial effusion (e). Fat components (*). Mild displacement of trachea (T) to the right is noted.
A case of
IgG4-related anterior mediastinal sclerosing disease coexisting with autoimmune pancreatitis. Anterior mediastinal mass. Chest computed tomography (CT) revealed a 2.5-cm well-defined homogenous mass in the anterior mediastinum at the time of diagnosis with autoimmune pancreatitis (a), and the tumor decreased in size to 2 cm on CT with oral steroid treatment 6 years ago (b). The tumor had regrown to 3 cm at the time of referral to our department on CT (c, d), and positron emission tomography showed a high maximum standardized uptake of 3.6 by the anterior mediastinal mass lesion (e)
A diagnostic
approach to the mediastinal masses. Non-seminomatous malignant germ cell tumour of the anterior mediastinum in a 25-year-old man with chest pain and high serum level of α-fetoprotein at admission (25.396 ng/ml). Frontal chest radiograph shows a central mass (*). The descending aorta is clearly seen (arrows), indicating that the mass is not within the posterior mediastinum. Multiple nodules in bilateral pulmonary field are also observed. A contrast-enhanced CT scan confirms a mass of low attenuation (*) in the anterior mediastinum that compresses the pulmonary artery. Bilateral lung metastasis (arrowheads) and hilar and subcarinal lymphadenopathy is identified (open arrows)
Anterior
mediastinal mass in the exam • Anterior mediastinal teratoma - Ganzer Fall bei Radiopaedia
Teratoma •
Anterior mediastinal teratoma - Ganzer Fall bei Radiopaedia
Anterior
mediastinal mass in the exam • Hodgkin lymphoma - mediastinal - Ganzer Fall bei Radiopaedia
Getting a film with an anterior mediastinal mass in the exam is one of the many exam set-pieces that can be prepared for.
The film goes up and after a couple of seconds pause, you need to start talking:
CXR
There is a left sided mediastinal mass that makes obtuse angles with the mediastinal contour. The hilar vessels can be seen through the mass - this is the hilum overlay sign and means this is not in the middle mediastinum. The paravertebral line can also be seen, placing this mass in the anterior mediastinum.
The differential includes lymphoma, thyroid malignancy, thymoma and teratoma and the age of the patient and accompanying clinical symptoms and signs would help order the list.
I would notify the referring clinician urgently and suggest a CT scan to assist diagnosis and assess the extent of disease.
CT
Selected axial and sagittal slices from a contrast enhanced CT chest.
This confirms that the mass is in the anterior mediastinum. There are fatty and calcific components suggesting a diagnosis of teratoma. A CT-guided biopsy could be performed to confirm the diagnosis.
Notes
- when the CT goes up - don't go back to the beginning. Use the phrase "this confirms..."
- where there is fat and calcification in an anterior mediastinal mass, think teratoma
- in lymphoma, Hodgkin's disease is more common in younger patients with lymphadenopathy isolated to the chest
See also
Siehe auch:
- Mediastinum
- Thymus
- Teratom
- Lymphom
- Perikard
- Keimzelltumor
- Schilddrüse
- Chorionkarzinom
- thorakales Aortenaneurysma
- mediastinales Teratom
- Morbus Hodgkin
- anterosuperior mediastinal mass (mnemonic)
- primäre Thymusneoplasien
- Normale Herzkonfiguration im Röntgen-Thorax
- Neoplasien der Schilddrüse
- vorderes Mediastinum
- hilum overlay sign
- mediastinales Seminom
- chest radiograph in the exam setting
- IgG4-assoziierte Erkrankung des Mediastinums
und weiter:
- Pancoast tumour
- Thymuskarzinom
- Thymom
- mediastinal lymphoma
- Thymuslipom
- Morbus Castleman
- invasives Thymom
- enlargement of the cardiac silhouette
- retrosternal airspace
- large-cell lymphoma of the mediastium
- mediastinale Keimzelltumoren
- mediastinale Raumforderungen
- thymic epithelial tumours
- Raumforderungen oberes Mediastinum
- obliteration of the retrosternal airspace
- adult chest radiograph set-pieces
- oberes Mediastinum
- Metastasen im Thymus
- Karzinoid des Thymus
- mediastinal malignant germinoma
- Teratom des Thymus
- hydatid cyst of the mediastinum
- lymphofollikuläre Thymushyperplasie
- Chondrosarkom des Sternums
- primäres Lymphom des Thymus
Assoziationen und Differentialdiagnosen zu Tumoren des vorderen oberen Mediastinums:
