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Differential Diagnosis

 

Lymphoma

Mediastinal Mass

Hodgkin Lymphoma (HL) and Non Hodgkins Lymphoma (NHL) can present with lymphadenopathy and or a mediastinal mass.

Also sometimes patients have systemic symptoms (B symptoms) of fevers, weight loss and night sweats.

 

Anterior Mediastinal Mass

Anterior mediastinum contains the thymus, heart, pericardium and anterior mediastinal lymph nodes.

This is the commonest site for a mediastinal tumor.

The chest X-ray below shows a massive anterior mediastinal mass secondary to acute lymphoblastic leukemia (#1).

It is possible to tell this is anterior by looking at the lateral film - #2 points to an area where there is complete filling of the retrosternal space by the mass.

 

 

Table : Differential Diagnosis of an anterior mediastinal mass

Congenital vs Acquired

 Normal Thymus

Biggest in children at 10yrs. Texture looks different from lymphoma on CT

Inflammatory

 Infection Bacterial - TB & atypical mycobacterium
Bacterial - staphylococcal
Fungal
Non-Infectious Reactive lymphadenopathy

Neoplastic

 Benign Benign Teratoma
Lymphangioma
Thymoma
Langerhans cell Histiocytosis
Malignant

Non Hodgkin Lymphoma

(Tcell lymphoblastic lymphoma commonest)

T cell Acute lymphoblastic leukemia
Malignant germ cell tumors
Hodgkin Lymphoma
Metastatic adenopathy

 

Below is a CT/PET scan of a patient with a large anterior mediastinal mass (#1). He has Hodgkin disease which is generally very FDG avid - this is the large white area seen.

 

Below is a CT scan on a 15 month old girl who presented with a mediastinal mass (#2). This is an anterior mass which has invaded the middle mediastinum. Initially this was felt most likely to be a necrotic tumour but the biopsy was positive for TB.

This is the same mediastinal mass (#2) secondary to TB (coronal section).

 

 

 

 

 

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