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:

• normal thymus
• lymphoma
• germ cell tumor
• thymoma
• lipoma