1. Is this study normal or abnormal?
The thoracic spine is normal. The study however is abnormal. There is widening of the superior anterior mediastinum, indicative of mass lesion and not to be missed!
The thoracic spine is normal. The study however is abnormal. There is widening of the superior anterior mediastinum, indicative of mass lesion and not to be missed!
2. If abnormal, what are your findings and what further imaging or follow up would be useful?
The classic differential anterior mediastinal masses includes the 4 T's:
Thymoma
Thyroid goiter
Teratoma
Terrible lymphoma
I would suggest using "terrible lymphadenopathy" for the fourth option as the differential in this form fails to take into account lymphadenopathy of other causes such as metastasis, as well as granulomatous disease of infectious (TB, mono, AIDS, etc) or non infectious (sarcoidosis, Wegener's granulomatosis, Castleman's disease) origin. Given the finding and the differential, a CT chest would be appropriate to help differentiate the source of the mass.
The CT scan of the chest shows multiple ovoid densities in the anterior mediastinum consistent with lymphadenopathy. As discussed above, this could represent malignant lymphadenopathy versus infectious or inflammatory cause. Subsequent histology studies revealed a diagnosis of Hodgkin's lymphoma.
Hodgkin's lymphoma is the amongst the most common cancer of young adults and most frequent type of lymphoma of the mediastinum. The lymph nodes can grow very rapidly and may be clinically silent until the nodes reach a large size. Anterior and/or middle mediastinal, and hilar mediastinal nodes may be involved. It is uncommon for the lungs to be the sole location of involvement, with abdominal lymph nodes, liver, spleen also potentially involved. CT or PET scans of the neck, chest, and abdomen is usually performed to assist with staging. This patient had lymphadenopathy limited to the anterior mediastium, indicative of stage 1 disease using Ann Arbor Staging Classification standards.
Clinically patient's may present with any or all of the following: fever, night sweats, pruritus, weight loss, weakness, fatigue. With mediastinal involvement there may be retrosternal or back pain, cough, difficulty breathing, pleural pain.
Treatment options include chemotherapy, corticosteroids, radiotherapy, and stem cell therapy either solely in any combination depending on response to care or recurrence.
Imaging of the chest in this patient 6 months post therapy are included below. They show significant resolution of the anterior mediastinal opacity.
Hodgkin's lymphoma is the amongst the most common cancer of young adults and most frequent type of lymphoma of the mediastinum. The lymph nodes can grow very rapidly and may be clinically silent until the nodes reach a large size. Anterior and/or middle mediastinal, and hilar mediastinal nodes may be involved. It is uncommon for the lungs to be the sole location of involvement, with abdominal lymph nodes, liver, spleen also potentially involved. CT or PET scans of the neck, chest, and abdomen is usually performed to assist with staging. This patient had lymphadenopathy limited to the anterior mediastium, indicative of stage 1 disease using Ann Arbor Staging Classification standards.
Clinically patient's may present with any or all of the following: fever, night sweats, pruritus, weight loss, weakness, fatigue. With mediastinal involvement there may be retrosternal or back pain, cough, difficulty breathing, pleural pain.
Treatment options include chemotherapy, corticosteroids, radiotherapy, and stem cell therapy either solely in any combination depending on response to care or recurrence.
Imaging of the chest in this patient 6 months post therapy are included below. They show significant resolution of the anterior mediastinal opacity.