Hypervascular mediastinal masses: Action points for radiologists

Cabral, Fernanda Caseira; Trotman‐Dickenson, Beatrice; Madan, Rachna

doi:10.1016/j.ejrad.2014.11.039

Cited by 11 publications

(16 citation statements)

References 31 publications

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“…Rarely, lymphoma may show avid enhancement, which can cause the radiologist to exclude Hodgkin lymphoma from the differential diagnosis. [ 10 ] Hypervascular mediastinal masses are characterized by intense enhancement after contrast administration, often with recruitment of adjacent abnormally enlarged feeding vessels. [ 10 ] The differential diagnosis of a hypervascular anterior mediastinal mass includes Castleman disease, paraganglioma, carcinoid, ectopic parathyroid adenoma, vascular malformation, and hypervascular nodal metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] Hypervascular mediastinal masses are characterized by intense enhancement after contrast administration, often with recruitment of adjacent abnormally enlarged feeding vessels. [ 10 ] The differential diagnosis of a hypervascular anterior mediastinal mass includes Castleman disease, paraganglioma, carcinoid, ectopic parathyroid adenoma, vascular malformation, and hypervascular nodal metastasis. [ 10 , 13 ] To the best of our knowledge, intense nodal enhancement with extreme hypervascularity in HL has not been previously reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 – 9 ] Rarely, lymphoma may show avid enhancement misleading radiologists in the differential diagnosis of a hypervascular mediastinal tumor. [ 10 ]…”

Section: Introductionmentioning

confidence: 99%

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Anterior mediastinal Hodgkin lymphoma presenting as an extremely hypervascular tumor on computed tomography

Lee

Rho²,

Kim³

et al. 2018

Medicine

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Rationale:In the thorax, Hodgkin lymphoma (HL) most frequently involves the anterior mediastinal and paratracheal regions and tends to spread to contiguous nodal groups. Enlarged lymph nodes typically have homogeneous soft tissue attenuation similar to that of muscle tissue on computed tomography (CT).Patient concerns:A contrast-enhanced CT examination of a 19-year-old man with right-sided chest pain showed an intense, heterogeneously enhancing mass with organization of serpentine and dilated blood vessels in the right anterior mediastinum that had invaded the upper lobe of the right lung.Diagnoses:Following a wedge resection, histopathological examination showed Reed-Sternberg cells that were positive for CD-15 and CD-30, which is typical of HL.Interventions:The patient was started treatment with 6 cycles of doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) regimen.Outcomes:After chemotherapy, the patient had shown a partial response to the treatment.Lessons:This presentation of HL as an extremely hypervascular anterior mediastinal mass on CT imaging has not been previously reported in the literature. This case suggests that HL should be included in the differential diagnosis of a hypervascular anterior mediastinal mass, especially if the patient is a young adult.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Anterior mediastinal Hodgkin lymphoma presenting as an extremely hypervascular tumor on computed tomography

Lee

Rho²,

Kim³

et al. 2018

Medicine

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“…They are divided into anterior, middle and posterior according to their location. Each compartment of mediastinal mass contains different differential diagnoses (4). Several entities such as Castleman disease, paraganglioma, vascular malformation, ectopic parathyroid adenoma and hypervascular metastasis should be taken into account as hypervascular anterior mediastinal masses are mentioned.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal hemangioma presenting with a characteristic feature on dynamic computed tomography images

Li¹,

Hsu²,

Gao³

et al. 2017

J. Thorac. Dis.

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Hemangiomas are uncommon benign tumors of the mediastinum. The definite diagnosis is sometimes difficult to make because of usually nonspecific features on single-phase contrast-enhanced computed tomography (CT) images. We described a 60-year-old woman suffering from a neck mass with progressive enlargement. On the dynamic CT study, the tumor showed peripheral nodular enhancement on early phase images and progressive centripetal fill-in on delayed phase images. Hemangioma was preoperatively diagnosed on the basis of this characteristic CT appearance. J Thorac Dis 2017;9(5):E412-E415 jtd.amegroups.com circumscribed mass in right superior mediastinum. The interface between the mass lesion and the thyroid gland was clear. A bronchogenic cyst was initially suspected according to its location and low attenuation on the pre-contrast images. However, due to a few peripheral enhancing foci seen on the post-contrast images, the possibility of a bronchogenic cyst was unlikely. In order to evaluate the nature and enhancing pattern of the mass, we performed a dynamic CT study with intravenous administration of 100 mL contrast medium at the rate of 3.5 mL/s by the powerful injector. Spiral scanning of the mediastinal mass was done repeatedly at 30 seconds, 1 minute and 3 minutes after injection. The mass revealed initially peripheral nodular enhancement with gradually central fill-in on the delayed phase images (Figure 2). The mediastinal hemangioma was first considered based on its enhancing pattern. Biopsy was not warranted due to high risk of major bleeding. The median sternotomy was performed for tumor resection. Grossly, the tumor revealed a well-circumscribed and hypervascular appearance (Figure 3). Pathological findings showed proliferation of small to medium-sized vessels with variable anastomosing channels ( Figure 4). The cavernous hemangioma was confirmed. DiscussionHypervascular mediastinal masses may show strong enhancement after contrast media administration. They are divided into anterior, middle and posterior according to their location. Each compartment of mediastinal mass contains different differential diagnoses (4). Several entities such as Castleman disease, paraganglioma, vascular malformation, ectopic parathyroid adenoma and hypervascular metastasis should be taken into account as hypervascular anterior mediastinal masses are mentioned.Mediastinal hemangiomas are very rare and consist of only 0.5% of mediastinal masses (5,6). According to International Society for the Study of Vascular Anomalies (ISSVA) classification, hemangiomas are classified into benign vascular tumors. They occur more frequently at the anterior mediastinum followed by posterior compartment. They also have a higher incidence before the age of 35 (5,7). At the histological examination, these tumors consist of interconnecting vascular spaces interposed with various stromal elements such as fat, myxoid and fibrous tissues. Organized thrombi in hemangiomas are frequent and may calcify as phleboliths that are a potentially dia...

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“…Less commonly, the paragangliomas are located in the posterior mediastinum and arise from the para-vertebral sympathetic chain ganglia. About 50% of posterior mediastinal paragangliomas are functional [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Mediastinal paragangliomas related to SDHx gene mutations

Michałowska¹,

Ćwikła²,

Prejbisz³

et al. 2016

kitp

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IntroductionParagangliomas (PGLs) related to hereditary syndromes are rare mediastinal tumors. Paragangliomas are caused by mutations in genes encoding subunits of succinate dehydrogenase enzyme (SDH).AimTo evaluate clinical, anatomical and functional characteristics of mediastinal paragangliomas related to SDHx gene mutations.Material and methodsRetrospective analysis of 75 patients with confirmed SDHx gene mutations (24 patients with SDHB, 5 SDHC, 46 with SDHD mutations) was performed. Patients underwent evaluation using computed tomography (CT), somatostatin receptor scintigraphy (SRS) (99mTc-[HYNIC,Tyr3]-octreotide), 123I mIBG scintigraphy and urinary excretion of total methoxycatecholamines.ResultsOut of 75 patients, 16 (21%) patients (1 SDHB, 15 SDHD mutations) had 17 PGLs localized in the mediastinum. Fourteen PGLs were localized in the middle mediastinum (intrapericardial) and 3 PGLs in the posterior mediastinum. The median diameter of paragangliomas measured on the axial slice was 24.3 mm (interquartile range (IQR): 14.7–36.6), and the median volume was 2.78 ml (IQR: 0.87–16.16). Twelve out of 16 patients (75%) underwent SRS, and 11 of them (92.3%) had pathological uptake of the radiotracer. Eleven (68.75%) out of 16 patients underwent 123 I mIBG, with only 3 positive results. Symptoms of catecholamine excretion were observed in 3 patients with PGLs localized in the posterior mediastinum. All PGLs were benign except in 1 patient with the SDHB mutation and PGL detected in the posterior mediastinum, who had a metastatic disease.ConclusionsMost mediastinal paragangliomas were related to SDHD gene mutations. They were asymptomatic, localized in the medial mediastinum, intrapericardially.

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Hypervascular mediastinal masses: Action points for radiologists

Cited by 11 publications

References 31 publications

Anterior mediastinal Hodgkin lymphoma presenting as an extremely hypervascular tumor on computed tomography

Anterior mediastinal Hodgkin lymphoma presenting as an extremely hypervascular tumor on computed tomography

Mediastinal hemangioma presenting with a characteristic feature on dynamic computed tomography images

Mediastinal paragangliomas related to SDHx gene mutations

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