Presentation
Chronic cough and recent shortness of breath. Apyrexic.
Patient Data
Moderate right sided pleural effusion.
Anterior mediastinal mass, with midline shift.
Left sided hilum overlay sign.
Large anterior mediastinal mass measuring 13 x 10 cm in bulk dimensions. Separate 4.2 cm right pericardial node.
Several nodules in the left lung involving the lingula and both lower lobes measuring up to 5.3 cm.
Trace of left pleural fluid. Right pleural drain. No residual effusion
Large volume creamy pleural drain content.
Bx of mediastinal mass undertaken
Biopsied report indicating a diffuse sclerosing Hodgkin lymphoma.
Case Discussion
Lots to see and think about with this case.
- Great chest x-ray: mediastinal mass, which would should be able to work out which mediastinal compartment it lies in. Hilum overlay sign evident.
- The differential for an anterior mediastinal mass - the 4T's.
- Chylothorax: indicating something is disrupting the thoracic duct.
- Role of CT is aiding a histological diagnosis through CT guided biopsy.
The appearances of the most fitting with a mediastinal lymphoma with pulmonary involvement, which was histologically confirmed.
A nice viva or long case for a fellowship exam, such as FRCR.