Presentation
Weight loss and cough. TB?
Patient Data
Age: 25 years
Gender: Female
Frontal
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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Axial C+ arterial phase
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.
Report
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.