Hodgkin lymphoma - mediastinal

Case contributed by Dr Ian Bickle

Presentation

Weight loss and cough. TB?

Patient Data

Age: 25 years
Gender: Female
X-ray

Chest radiograph

Near symmetrical upper anterior mediastinal mass. Left sided hilar overlay sign.

Heart size normal. Lungs clear.

CT

CT CHEST

Large anterior mediastinal mass with bulk dimensions of 7.2 x 5cm. Lungs clear. Bilateral lymph node enlargement at the root of the neck.

CT ABDOMEN

Extensive para-aortic, celiac axis, porta hepatis and iliac lymph nodes measuring up to 2.3 cm. Solid organs normal. No focal bone lesion.

Photo

Excision biopsy of a neck node undertaken.

Reports in keeping radiological suspicious of lymphoma.

Case Discussion

A good case for long case or viva of a fellowship examination.

Start with the plain film to assess:

  • the candidate's approach to a common film
  • their understanding of how to determine mediastinal compartment the pathology lies in
  • knowledge to give a reasonable differential diagnosis
  • to 'earn' the CT to give a more confident definitive diagnosis
  • question on the best method of ascertaining a tissue diagnosis

Additional discussion of US-guided neck node biopsy vs surgical excision vs CT-guided mediastinal mass biopsy. 

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Case information

rID: 47307
Published: 24th Aug 2016
Last edited: 2nd Sep 2018
Inclusion in quiz mode: Included
Excluded from licensing

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