Case contributed by Ryan Thibodeau
Diagnosis certain


Seizure-like activity at outside hospital.

Patient Data

Age: 7 years
Gender: Female

The overall attenuation is less than that of muscle and closer to fluid, without obvious enhancement. There are, what appear to be, punctate calcifications without a "mural nodule" or large high density, more solid component. The mass appears to be fairly well-defined without infiltration into the adjacent soft tissues. There is no obvious extension into the neural foramina/spinal canal.

The mass is slightly deviating the mediastinal structures without significant midline shift or crossing the midline.


There is a massive posterior mediastinal mass involving the superior left hemithorax extending from approximately the T1 through the T8 level measuring up to 10.6 x 7.1 x 8.2 cm. The mass is isointense to muscle on T1-weighted images and demonstrates rounded areas of high signal on T2-weighted sequences compatible with areas of tumor necrosis.

The mass appears to extend from the left neural foramen at the T2-3 level but does not extend into the epidural space. There is no evidence of cervical or upper thoracic spinal cord compression at any level.

The mass abuts the posterior intercostal muscles and may be invading them. There is pressure erosion of the third posterior rib but there is no evidence of cortical destruction.

The mass displaces the aorta to the right, while the left carotid artery and proximal left subclavian are displaced cephalad. The mid and distal left subclavian are displaced by the mass and the left subclavian artery may be partially encased.

Case Discussion

This is a case of a pathologically-proven ganglioneuroma. Gross pathologic examination revealed a soft, pink/red fibromembranous mass measuring 11.0 cm x 9.1 cm x 8.6 cm. Histopathologic examination demonstrated stroma of ganglion and Schwannian cells.

Patient did well post-operatively but developed left-sided Horner’s syndrome, which was improving at the one year follow-up appointment.

Alannah McCann
Travis Bevington, MD

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