Anterior mediastinal mass in the exam
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:
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.
I would notify the referring clinician urgently and suggest a CT scan to assist diagnosis and assess the extent of disease.
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.
- 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