Presentation
MVA.
Patient Data
The lungs and pleural spaces are clear. No pneumothorax. The right lower zone contains a rounded opacity obscuring the lower half of the right heart border. Cardiomediastinal contours are otherwise normal allowing for projection. No free subdiaphragmatic gas. No fracture evident.
Impression
The right lower zone rounded opacity is of unknown significance and may represent a prominent pericardial fat pad, mediastinal mass or pleural based mass abutting the pericardium. Further assessment with CT is advised.
The right mediastinal mass abutting the right heart border is fat density and measures 60 mm in diameter. Posteriorly there is a small focus of calcification. It is contiguous with peritoneal fat and protrudes through a round anterior right diaphragmatic defect 20 mm in diameter.
The heart and great vessels are unremarkable. No pericardial thickening or effusion. No incidental pulmonary embolus. No lymphadenopathy. The lungs and pleural spaces are clear.
Incidental heterogeneous hypodense left thyroid lesion 25 mm in diameter - outpatient ultrasound follow-up suggested.
Baggy renal pelvis in the left kidney. Otherwise the upper abdominal organs are unremarkable.
No fracture. Partially-imaged degenerative L2/3 disc.
Impression
The right mediastinal mass corresponds to a Morgagni hernia containing peritoneal fat. This is likely to be congenital and does not require further follow-up.
Case Discussion
The patient reported a previous CT a decade ago in another country showed 'fatty mass next to my heart'.
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