Today I am presenting chest radiographs of a 61-year-old man, asymptomatic.
What would be your diagnosis?
4. Any of the above
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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!”
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.
Possibly thymic tumor such as thymoma, further CT is helpful.
Any if above..next CT chest with contrast is suggested
Anterior mediastinal mass – any of the above answer 4.
Furhter analisis in CT
….penso ad un lipoma ….anche se la regola delle 4 T nel mediastino anteriore , va tenuta presente
Nomor 3 Advise : Chest CT scan and Contrast media
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.
But teratoma not common at this age group