Presentation
Chest pain and dyspnea
Patient Data
The frontal chest radiograph shows a large soft tissue density on the left side with no obliteration of the left hilar vessels which are visible through the mass 'hilum overlay sign" indicating the anterior or posterior location of the lesion. Note that the descending thoracic aorta (which is posterior) is not obliterated, indicating the anterior location of the mass. The lungs and pleura appear unremarkable.
The lateral chest radiograph confirms the anterior location of the mass.
The ultrasound of the anterior mediastinum demonstrates a well-defined upper mediastinal hypoechoic heterogeneous mass in contact with the pulmonary trunk.
CT confirms that the mass is in the anterior mediastinum (lateralized to the left). It is relatively well-circumscribed, with no evidence of invasion of the mediastinal structures, but with irregular interface with the adjacent left upper lobe. It contains air-bubbles (invasion of the adjacent lung parenchyma ?). No significant enhancement seen on the postcontrast sequences.
The previously described mass demonstrates an intermediate signal on T1WI/T2WI with areas of high signal T2WI and restricted diffusion on DWI/ADC. No significant enhancement seen on postcontrast sequences. No mediastinal or hilar lymphadenopathy seen.
Case Discussion
The patient went on to have total resection of the mediastinal mass with left upper lobectomy (the tumor was adherent to the left upper lobe). The histopathological exam with immunochemistry confirmed the diagnosis of a mediastinal high-grade pleomorphic sarcoma.
Malignant pleomorphic sarcoma can occur almost anywhere in the body, but the mediastinal location is extremely rare.
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