CT diagnosis of benign mediastinal abnormalities

Pugatch, Robert D.; Faling, LJ; Robbins, AH; Spira, Richard

doi:10.2214/ajr.134.4.685

Cited by 64 publications

(16 citation statements)

References 11 publications

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“…The multitude of diseases affecting the mediastinum varies considerably, comprising of tumours (benign to extremely malignant), cysts, vascular anomalies, lymph node masses, mediastinitis, mediastinal fibrosis and pneumomediastinum. CT clearly demonstrates the malleable nature of the cysts, which change their shape with respect to change in position from prone to decubitus [2] .…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic evaluation of mediastinal masses/lesions with contrast enhancement and correlation with pathological diagnosis – a study of 120 cases

Kaur¹,

Tiwari²,

Dugg

et al. 2014

JBGC

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Objective: The study was conducted to diagnose the mediastinal lesions/masses by computed tomographic on contrast enhanced scans and findings were compared with pathological diagnosis wherever possible. Methods:Contrast Enhanced Computed Tomography (CECT) of chest done in supine position in inspiration with 60 to 120 ml of 300 mg/ml of nonionic iodinated contrast and images were viewed in lung window (level 700 HU; width 1,500 HU), mediastinal window (level 30 HU-50 HU; width 350 HU-500 HU) and bone window (level 2,400 HU; width 200 HU). Results:The most common compartment to be involved was anterior mediastinum (38.3%) followed by posterior (16.7%), middle (13.3%) and superior mediastinum (11.7%) in that order. Predominant lesions were benign. The commonest lesion was tubercular lymphadenopathy (15%). Thymic masses and metastatic lymph node (26% each) were the most common mediastinal lesions in the anterior mediastinal compartment. Neural tumors (50%), esophageal carcinoma (37.5%) and thyroid masses (85.7%) were the common lesions in posterior, middle and superior mediastinal compartments respectively. Ascending aortic aneurysm was the predominant vascular lesion in our study (6.7%). Out of total 120 cases, 102 cases were histologically verified, six cases with hiatal hernia were confirmed with endoscopy while in 12 cases of vascular origin, and definitive diagnosis was established with Computed tomography (CT) scan alone. Conclusions:CT scan can distinguish specific tissue densities and its ability to display mediastinum in axial plane makes it a useful technique in the evaluation of a mediastinal mass.

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Section: Introductionmentioning

confidence: 99%

Computed tomographic evaluation of mediastinal masses/lesions with contrast enhancement and correlation with pathological diagnosis – a study of 120 cases

Kaur¹,

Tiwari²,

Dugg

et al. 2014

JBGC

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“…It may be due to malignant or benign tumors, 1,2 such as carcinoma, lymphoma, thymoma, teratoma cyst, lipomatosis and aneurysms of the great vessels. Unusual causes reported include superior vena cava thrombosis, 3 multiple leutic saccular aneurysms of the aorta, 4 congenital aortic elongation, 5 aneurysm of the left brachiocephalic vein, 6 intravascular lipoma of the superior vena cava, 7 mediastinal abscess, 8 traumatic esophageal rupture, 9 and traumatic cerebrospinal fluid leak in children.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal Widening due to Lipomatosis and Herniated Liver and Stomach

2000

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A Al-Adsani, MH Dahniya, A Al-Beltagi, Mediastinal Widening Due to Lipomatosis and Herniated Liver and Stomach. 2000; 20(3-4): [288][289][290] Mediastinal widening on a conventional chest radiograph is a common and often challenging clinical problem. It may be due to a number of conditions, which may either be benign or malignant, normal or unusual. Computed tomography (CT) is now the initial, and in most instances, the definitive imaging modality for evaluating a widened mediastinum. We report here a case of an obese woman in whom mediastinal widening was due not only to mediastinal lipomatosis, but also to a large anterior abdominal wall defect through which the stomach and liver had herniated. We also briefly review some aspects of mediastinal widening. Case ReportA 51-year-old hypertensive woman presented with a one-month history of progressive exertional dyspnea, snoring and inability to lie flat. She gave a three-year history of assumed bronchial asthma, for which she was irregularly taking inhaled bronchodilator and steroids. Clinical examination revealed a very obese woman (weight 110 kg), with a need to sit in a propped up position. Her blood pressure was 150/90 mm Hg, and there were no other abnormal findings in the cardiovascular and respiratory systems. The abdomen was fatty and pendulous, with a supraumbilical hernia and a lower abdominal cesarian scar. Hematological and biochemical investigations were all normal, except for fasting serum glucose of 7.1 mmol/L (normal 3.9-6.1) and total cholesterol of 5.32 mmol/L (normal 3.9-5.2). The ECG record showed a sinus regular rhythm with inverted T in L1 and aVL. A posteroanterior chest radiograph revealed moderate cardiomegaly, a dilated and unfolded aorta, narrowing of the coronal diameter (9.6 mm) of the intrathoracic portion of the trachea (normal range 14.4 to 18.2 mm in women), with a slight tracheal shift to the right and widening of the mediastinum (Figure 1), which was further evaluated by contrast-enhanced CT scan. Conventional 10 mm axial images were acquired from apex to base on a helical scanner (GE Sytex 2000, GE Medical Systems, Milwaukee, USA), following intravenous injection of 100 mL of Omnipaque (350 mgI/mLNycomed). CT of the chest showed the excessive fat surrounding the upper and mid-mediastinal structures ( Figures 2 and 3, respectively). In addition to the obvious mediastinal and abdominal lipomatosis, there was a large defect of the upper anterior abdominal wall (remote from the lower cesarian scar), through which a large part of the liver and stomach had herniated (Figures 4 and 5). These herniated structures were contributing significantly to the mediastinal widening in addition to the lipomatosis. There was cardiomegaly but the lungs were normal. Echocardiogram revealed normal systolic and impaired diastolic function of the left ventricle (ejection fraction was 70%), with left ventricular hypertrophy, mild mitral regurgitation, and mild enlargement of left atrium. She was advised to reduce her weight, and her blood pressure was ...

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“…Pugatch et al [6] sug gested that CT of the thorax should be the first diag nostic procedure in the evaluation of asymptomatic patients with mediastinal mass on standard chest X-ray. If CT shows a fatty lesion, with characteristic attenuation coefficients of -50 to -150 HU, regular follow-up only is justified [4].…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic Lipomas Demonstrated By Computed Tomography

Barış

Kalyoncu²,

Aydıner³

et al. 1990

Respiration

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Nine cases of intrathoracic lipoma are reported. Computed tomography (CT) proved to be helpful in the diagnosis and management of these cases. The attenuations of the masses ranged from -70 to -140 Hounsfíeld units (HU). In 4 cases, needle biopsies were taken, confirming lipoma with mature fat cells. One patient also had a coelomic cyst with an attenuation of 20 HU, which was confirmed at thoracotomy. Another had an atypical lipoma which infiltrated the thoracic wall but was benign. In conclusion, we recommend investigation with CT scan for the diagnosis of lipoma

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CT diagnosis of benign mediastinal abnormalities

Cited by 64 publications

References 11 publications

Computed tomographic evaluation of mediastinal masses/lesions with contrast enhancement and correlation with pathological diagnosis – a study of 120 cases

Computed tomographic evaluation of mediastinal masses/lesions with contrast enhancement and correlation with pathological diagnosis – a study of 120 cases

Mediastinal Widening due to Lipomatosis and Herniated Liver and Stomach

Intrathoracic Lipomas Demonstrated By Computed Tomography

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