Presentation
Dyspnea and cough with an abnormal chest X-ray.
Patient Data
There is a mediastinal mass projecting to the left side with hilum overlay sign and right pleural effusion.
A large soft tissue attenuation mass occupying the anterior mediastinal displaying homogenous attenuation with low density areas of cystic changes inside. It extends to the middle mediastinum to occupy the pretracheal space and involve the right hilum. Inferiorly it is inseparable from the anterior pericardium. Compression upon the SVC and encasement of aorta and great vessels are noted. There is also mild right costal pleural thickening and enhancement suggesting infiltration with mild pleural effusion and abdominal retrocaval lymph nodes.
Case Discussion
Differential diagnosis of an anterior mediastinal mass in children includes:
- normal thymus
- thymic hyperplasia and thymoma, thymolipoma, thymic cyst and carcinoma
- lymphoma
- teratoma
- lipoma
- lymphangioma
- pleuropericardial cyst
- Morgagni hernia
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