Dr. Pepe’s Diploma Casebook: CASE 128 – SOLVED!

Dear Friends,

Today I am presenting chest radiographs of a 61-year-old man, asymptomatic.
What would be your diagnosis?

1. Thymoma
2. Teratoma
3. Lipoma
4. Any of the above

You have two days to post your answers. The correct answer will be given during the webinar of next Wednesday at 12:30 noon; you can join the webinar here

Click here for the answer

Findings: chest radiographs demonstrate an anterior mediastinal mass (A and B, arrows). In an asymptomatic patient, thymoma or teratoma are the best possibilities. A lipoma cannot be excluded because fat cannot be distinguished from soft tissues in the plain film. Therefore, the correct answer should be: 4. Any of the above.

Enhanced coronal and axial CT show an uniform fatty mass in the anterior mediastinum (C and D, arrows)

Final diagnosis: mediastinal lipoma

Congratulations to Katarzyna, who was the first to give the correct answer

Teaching point: remember that fat density cannon be distinguished from soft-tissue density in the plain film

This is the last Diploma case of the season. Will be back in September with new cases

As announced, Dr. Pepe solved this case (amongst others) during the webinar. If you did not have the opportunity to watch the webinar live, you can watch it now on the EBR webpage.

Enjoy your vacation!

10 thoughts on “Dr. Pepe’s Diploma Casebook: CASE 128 – SOLVED!

  1. Good Morning!

    We can see an anterior mediastinal mass of soft tissue density, but without a CT we can’t tell more. So my answer is nr 4.


  2. I think that it’s probably a teratoma because:
    -thymoma often enlarges the superior mediastinum, that in this Rx appears normal.
    -lipoma has a low density, so in the most of cases it’s not a well defined mass as in the Rx.


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