Chylothorax due to Hodgkin lymphoma

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Chronic cough and recent shortness of breath. Apyrexic.

Patient Data

Age: 20 years
Gender: Male

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.

Large volume creamy pleural drain content.

Bx of mediastinal mass...

pathology

Bx of mediastinal mass undertaken

Biopsied report indicating a diffuse sclerosing Hodgkin lymphoma.

Case Discussion

Lots to see and think about with this case.

  1. Great chest x-ray: mediastinal mass, which would should be able to work out which mediastinal compartment it lies in. Hilum overlay sign evident.
  2. The differential for an anterior mediastinal mass - the 4T's.
  3. Chylothorax: indicating something is disrupting the thoracic duct.
  4. 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.

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