Presentation
Increasing shortness of breath over the last few weeks.
Patient Data
On the frontal projection, there is a large opacity in the left mid and lower zone, with somewhat well defined upper border. The left cardiac border, hilum and left hemidiaphram are all silhouetted by the opacity. The trachea and heart are deviated to the right side. No evidence of definite calcification within the mass. The right lung appears unremarkable.
On the lateral projection, the retrosternal space (normally air lucent) appears to be filled with the mass. The anterior cardiac border is silhouetted by the mass also. Left hemidiaphragm is not seen.
Impression: Imaging appearances are very suggestive of antero-superior mediastinal mass.
There is a huge heterogenous antero-superior mediastinal mass, mainly of fat density with thick soft tissue strands within, without calcification or fat-fluid level. Most of the left lung (except for apico-posterior segment of the upper lobe) is completely collapsed. Moderate shift of the mediastinum and the heart to the right side. The mass effect on the left pulmonary vessels and major airways is also obvious. Superior venal cava is patent and not compressed.
No pleural effusion. Incidental note of enlarged left thyroid lobe with retrosternal extension.
Imaged upper abdomen is unremarkable.
Impression: Imaging appearance are highly suggestive of a thymolipoma. Mediastinal liposarcoma thought very unlikely.
Case Discussion
The patient underwent surgical resection of the huge mass and the histopathology revealed thymolipoma. He had a relatively uneventful post-operative course, apart from an easily managed pneumothorax.