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Age: 2 weeks

Sex: Male

Indication: Tachypnea

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Case #23


Findings

  • Right posterior mediastinal mass measuring approximately 2.5 x 2.5 cm on the frontal view with associated rib splaying (right third and fourth ribs) and anterior displacement of the trachea
  • No focal airspace opacification, pleural effusion, or pneumothorax
  • Normal size and configuration of the cardiothymic silhouette


Diagnosis

  • Posterior mediastinal mass (thoracic neuroblastoma)

Sample Report

Right posterior mediastinal mass measuring approximately 2.5 x 2.5 cm on the frontal view with associated splaying of the right third and fourth ribs and anterior displacement of the trachea. Recommend chest CT for further evaluation.

No focal airspace opacification, pleural effusion, or pneumothorax.

Normal size and configuration of the cardiothymic silhouette.


Discussion

  • Posterior mediastinal masses are often difficult to identify. Get used to looking for signs of mass effect like rib splaying and deviation of structures like the trachea to help increase your sensitivity for these masses
  • This case went on to biopsy with pathology showing thoracic neuroblastoma


Images

Red arrows: posterior mediastinal mass. The upper right cardiothymic silhouette is NOT obscured, indicating that this mass is not in the anterior or middle mediastinum. Red line: splaying of the 3rd and 4th ribs. Red arrows: posterior mediastinal mass which displaces the trachea anteriorly. Red arrows: partially calcified right posterior mediastinal mass confirmed on the subsequent chest CT. This imaging appearance is typical for thoracic neuroblastoma in this age group.

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