Presentation
Confirmation CXR for placement of PICC line.
Patient Data
Frontal
Ovoid mass in the left hilum. The hilar vessels are still visible (hilum overlay sign).
Thickening of the right paratracheal stripe. Right sided central venous catheter with the tip correctly sited.
No aggressive osseous lesions or pleural effusion.
Lateral
Loss of the retrosternal clear space.
The features are of a large B cell lymphoma of the mediastinum. There is co-expression of CD30 which would be in keeping with a primary mediastinal large B cell lymphoma.
Case Discussion
The mediastinal mass is able to be localized by assessing if the hilar vessels are visible through it. If they are, it implies the mass is in the anterior or posterior mediastinum. The lateral film confirms the mass is in the anterior mediastinum as the retrosternal clear space is effaced by a soft tissue density. The patient went on to have biopsy of the mediastinal mass which was reported as a large B cell lymphoma of the mediastinum.
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