Presentation
Weight loss and cough. TB?
Patient Data
Age: 25 years
Gender: Female
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Near symmetrical upper anterior mediastinal mass. Left sided hilar overlay sign.
Heart size normal. Lungs clear.
From the case:
Hodgkin lymphoma - mediastinal
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portal venous phase"}],"caption":{"us":null,"gb":null},"findings":{"us":"\u003cp\u003eCT CHEST\u003c/p\u003e\u003cp\u003eLarge anterior mediastinal mass with bulk dimensions of 7.2 x 5cm. Lungs clear. Bilateral lymph node enlargement at the root of the neck.\u003c/p\u003e\u003cp\u003eCT ABDOMEN\u003c/p\u003e\u003cp\u003eExtensive para-aortic, celiac axis, porta hepatis and iliac lymph nodes measuring up to 2.3 cm. Solid organs normal. No focal bone lesion.\u003c/p\u003e","gb":"\u003cp\u003eCT CHEST\u003c/p\u003e\u003cp\u003eLarge anterior mediastinal mass with bulk dimensions of 7.2 x 5cm. Lungs clear. Bilateral lymph node enlargement at the root of the neck.\u003c/p\u003e\u003cp\u003eCT ABDOMEN\u003c/p\u003e\u003cp\u003eExtensive para-aortic, coeliac axis, porta hepatis and iliac lymph nodes measuring up to 2.3 cm. Solid organs normal. No focal bone lesion.\u003c/p\u003e"},"contributor_login":"clonvara","case_id":47307,"case_key_image_id":24675685,"case_featured_at":"17 Sep 2016"},"current_user":null,"access":{"can_edit":false,"can_download":true,"can_toggle_annotations":true,"can_feature":false,"can_pin":false}}
CT CHEST
Large anterior mediastinal mass with bulk dimensions of 7.2 x 5cm. Lungs clear. Bilateral lymph node enlargement at the root of the neck.
CT ABDOMEN
Extensive para-aortic, celiac axis, porta hepatis and iliac lymph nodes measuring up to 2.3 cm. Solid organs normal. No focal bone lesion.
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Excision Bx of a neck node undertaken
Reports in keeping radiological suspicious of lymphoma.
Case Discussion
A good case for long case or viva of a fellowship examination.
Start with the plain film to assess:
- the candidate's approach to a common film
- their understanding of how to determine mediastinal compartment the pathology lies in
- knowledge to give a reasonable differential diagnosis
- to 'earn' the CT to give a more confident definitive diagnosis
- question on the best method of ascertaining a tissue diagnosis
Additional discussion of US-guided neck node biopsy vs surgical excision vs CT-guided mediastinal mass biopsy.