Hodgkin lymphoma - mediastinal

Case contributed by Dr Ian Bickle

Presentation

Weight loss and cough. TB?

Patient Data

Age: 25 years
Gender: Female

Chest radiograph

X-ray

Near symmetrical upper anterior mediastinal mass. Left sided hilar overlay sign.

Heart size normal. Lungs clear.

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.

Excision biopsy of a neck node undertaken.

Photo

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. 

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