Mediastinal lymphoma

Case contributed by Dr Mostafa Mohamed

Presentation

Shortness of breath

Patient Data

Age: 3 years
Gender: Male
ct

The main finding of the study is the presence of ill-defined heterogeneous soft tissue mass with foci of calcification in the anterior mediastinum, extending downward to the anterior pericardium. The mass encases the superior mediastinal vessels with no gross evidence of infiltration or compression, shows faint heterogeneous post-contrast enhancement with areas of necrosis. There is associated mild pericardium thickening and pericardial effusion with cardiomegaly and myocardial thickening. There is also right-sided mild hydropneumothorax extending to the fissures with an intrathoracic chest drain in place.

Massive bilateral anterior as well as posterior chest walls surgical emphysema more evident at the right side.

Few enlarged prevascular, aortopulmonary, as well as retrocaval lymph nodes.

Few tiny mesenteric lymph nodes.

Case Discussion

Pleural effusion cytology:

Hypercellular smears show atypical monomorphic lymphoid cells infiltrate with evidence of karyorrhexis. The picture is suspicious of the lymphoid neoplasm.

Echocardiography:

Bilateral dilatation and diminutive ventricles with impaired relaxation pattern in tissue Doppler,  the texture of myocardium is suggestive of infiltrative disease (picture suggestive of restrictive cardiomyopathy), a moderate amount of pericardial fluid and pericardial shreds and debris.

Lymphoma accounts for about 45% of anterior mediastinal mass in children.

Most common clinical presentation :

  • cough
  • shortness of breath
  • chest pain

The differential diagnosis for an anterior mediastinal mass in children:

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