CT - Chest CT with contrast
- poorly enhancing, heterogeneous soft tissue attenuating mediastinal mass extends from the SVC origin to the proximal region of the bilateral major bronchus and subcarinal space. Mediastinal fat planes obliterated by the mass
- major mediastinal vessels were also enclosed by the lesion: SVC, ascending aorta, arch and proximal portion of the descending aorta
- SVC narrowed with collateral vein development, and contrast filling of the left dorsal scapular vein, internal thoracic vein, superior epigastric vein, ascending lumbar vein, and azygos vein
- the focal hepatic hot spot sign, also known as the hot quadrate lobe sign, is caused by preferential enhancement of the medial segment of the left hepatic lobe suggesting collateral pathways with paraumblical veins
- related pleural effusion is visible on a bilateral pleural cavity
- calcifications can be seen in the hepatic parenchyma, splenic parenchyma, and mediastinal hilum. Additionally, there are spots of calcification in the mass at the left upper paratracheal region. All of these in keeping with granulomata
- no evidence of pulmonary infiltrates