Hilum overlay sign - mediastinal lymphoma

Case contributed by Dr Arkadi Tadevosyan


Two months postpartum with a persistent cough.

Patient Data

Age: 30 years
Gender: Female

Well defined soft tissue density projecting over the right hilum. Hilar vessels can be still appreciated. Lateral projection confirms that the mass is located in the anterior mediastinum. 

An excellent example of the hilum overlay sign.

There is an anterior mediastinal mass measuring 8.9 x 5.1 cm with heterogeneous enhancement and multiple cystic areas. Branches of the right superior pulmonary veins are partially compressed and displaced laterally.

Right supraclavicular, upper paratracheal and prevascular lymph nodes are also enlarged.

There is patchy consolidation and centrilobular nodules seen in the lung parenchyma adjacent to the mediastinal mass.

There is no compression upon the SVC or encasement of the aorta and greater vessels.

Case Discussion

Differential diagnoses of an anterior mediastinal mass include:

  • thymic lesions
  • germ cell tumors
  • thyroid and parathyroid lesions
  • mediastinal lymphoma
  • thoracic aortic aneurysm

Histology confirmed nodular sclerosing subtype of Hodgkin's lymphoma.

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Case information

rID: 53664
Published: 19th Jun 2017
Last edited: 24th Oct 2020
Inclusion in quiz mode: Included

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