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Mediastinal Mature Teratoma

Cunningham PJC - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Mediastinal Mature Teratoma

History: 9 y.o. girl with several month history of dull, intermittent, substernal chest pain - relieved by sitting up and treated with NSAIDs.

Findings: • PA and lateral chest radiographs: Large, circumscribed anterior mediastinal mass abutting the ascending aorta, pulmonary artery, and left heart border. No evident adenopathy or pleural effusion. • Contrast-enhanced chest CT: Circumscribed, heterogeneous anterior mediastinal mass containing multiple components with fluid and fat attenuation but no calcifications. The mass abuts and displaces the thymus - but appears separate. No adenopathy or evidence of local invasion.

Ddx: » The differential diagnosis for a child with a mediastinal mass on CXR includes: • thymoma • thymic carcinoid • thymic carcinoma • thymic cyst • thymolipoma • lymphoma • germ cell tumors (including teratoma & seminoma) • parathyroid adenoma • lymphangioma • intrathoracic goiter » The most common of these are thymoma, germ cell tumor, substernal goiter, and lymphoma. All the other conditions are rare. » In this patient the CT appearance, especially the presence of fat, is highly specific for a teratoma. » Additionally, the lack of contiguity of the mass with the thyroid makes goiter very unlikely, the patient's sex makes a malignant germ cell tumor unlikely, the absence of adenopathy elsewhere argues against lymphoma, and her age makes thymoma unlikely.

Dxhow: Imaging, surgery, pathology

Exam: Physical examination unrevealing. EKG normal.

No MeSH data available.


Selected images from a contrast-enhanced chest CT showing a circumscribed anterior mediastinal mass abutting and displacing the thymus.  The mass contains large loculations with fluid and fat attenuation. No evidence of invasion or nodal metastasis.
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MPX2151_synpic1008: Selected images from a contrast-enhanced chest CT showing a circumscribed anterior mediastinal mass abutting and displacing the thymus. The mass contains large loculations with fluid and fat attenuation. No evidence of invasion or nodal metastasis.


Mediastinal Mature Teratoma

Cunningham PJC - MedPix (2006)

Selected images from a contrast-enhanced chest CT showing a circumscribed anterior mediastinal mass abutting and displacing the thymus.  The mass contains large loculations with fluid and fat attenuation. No evidence of invasion or nodal metastasis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2151&req=5

MPX2151_synpic1008: Selected images from a contrast-enhanced chest CT showing a circumscribed anterior mediastinal mass abutting and displacing the thymus. The mass contains large loculations with fluid and fat attenuation. No evidence of invasion or nodal metastasis.

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Mediastinal Mature Teratoma

History: 9 y.o. girl with several month history of dull, intermittent, substernal chest pain - relieved by sitting up and treated with NSAIDs.

Findings: • PA and lateral chest radiographs: Large, circumscribed anterior mediastinal mass abutting the ascending aorta, pulmonary artery, and left heart border. No evident adenopathy or pleural effusion. • Contrast-enhanced chest CT: Circumscribed, heterogeneous anterior mediastinal mass containing multiple components with fluid and fat attenuation but no calcifications. The mass abuts and displaces the thymus - but appears separate. No adenopathy or evidence of local invasion.

Ddx: » The differential diagnosis for a child with a mediastinal mass on CXR includes: • thymoma • thymic carcinoid • thymic carcinoma • thymic cyst • thymolipoma • lymphoma • germ cell tumors (including teratoma & seminoma) • parathyroid adenoma • lymphangioma • intrathoracic goiter » The most common of these are thymoma, germ cell tumor, substernal goiter, and lymphoma. All the other conditions are rare. » In this patient the CT appearance, especially the presence of fat, is highly specific for a teratoma. » Additionally, the lack of contiguity of the mass with the thyroid makes goiter very unlikely, the patient's sex makes a malignant germ cell tumor unlikely, the absence of adenopathy elsewhere argues against lymphoma, and her age makes thymoma unlikely.

Dxhow: Imaging, surgery, pathology

Exam: Physical examination unrevealing. EKG normal.

No MeSH data available.