대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 912 Date 2015-04-20

  • Courtesy of Jihang Kim, Kyung Won Lee / Bundang Seoul National University Hospital
  • Age/Sex 24 / M
  • Chief ComplaintIncidentally detected abnormality on chest PA.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Mediastinal and intrapulmonary lymphangioma
Radiologic Findings
Chest radiograph (Fig. 1) shows a bulging contour at the azygoesophageal recess and the descending aortic interface. Coarse reticular opacities in the left retrocardiac area were also noted.
Contrast-enhanced axial (Figs. 2, 3) and coronal (Figs. 4, 5) CT images show a well-defined and low-attenuating mass encasing the esophagus and the descending thoracic aorta in the posterior mediastinum. Images in the lung window setting show a localized bronchovascular bundle and interlobular septal thickening in the left lower lobe adjacent to the mass in the posterior mediastinum.
Brief Review
VATS mass excision, posterior mediastinum; lymphangioma
Similar to cystic hygromas, mediastinal lymphangiomas are congenital anomalies that are usually identified in the perinatal period or in childhood. Mediastinal lymphangiomas are sometimes related to cystic lymphangiectasis of the lung, which is frequently a fatal condition for neonates. Unlike cystic lymphangiectasis, the cyst walls of lymphangiomas are thicker and more fibrous. Adult lymphangiomas rarely affect the pulmonary parenchyma and lymphangiomas involving both the lung and the mediastinum have rarely been described.
Lymphangiomas are focal proliferations of lymphatic tissue in which cystic spaces are filled with proteinaceous fluid. They are frequently detected incidentally on chest radiographs. Although CT can provide helpful information regarding the site and size of the lesion, it cannot conclusively make a diagnosis of lymphangioma. Thus, diagnosis is made using histopathologic examinations and MRI is considered the diagnostic modality of choice for lymphangiomas as it can predict subsequent intraoperative findings.
References
1. Adult intrapulmonary and mediastinal lymphangioma causing haemoptysis. Holden WE, Morris JF, Antonovic R, Gill TH, Kessler S. Thorax 1987
2. Late presentation of primary pulmonary lymphangiectasis. Wagenaar SS, Swierenga J, Wagenvoort CA. Thorax 1978
3. Thoracic lymphangiomas, lymphangiectasis, lymphangiomatosis, and lymphatic dysplasiasyndrome. Faul JL, Berry GJ, Colby TV, Ruoss SJ, Walter MB, Rosen GD, Raffin TA. Am J Respir Crit Care Med 2000

Please refer to
Case 102 Case 207 Case 33 Case 562 Case 819 Case 833
Keywords
Lung, Mediastinum, Congenital, Vascular malformation,

No. of Applicants : 83

▶ Correct Answer : 35/83,  42.2%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Seoul National University Hospital , Korea (South) Hyun-ju Lim
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - GHICL , France manuel toledano
  • - SNUH , Korea (South) Eui Jin Hwang
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Ajou University hospital , Korea (South) Hun Cho
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - university of montreal , Canada Andrei Gorgos I
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kosin University Gospel Hospital , Korea (South) Hee Kang
  • - Niigata University , Japan Atsushi Uehara
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - CNUH , Korea (South) Noh Hoon
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - Asan , Korea (South) Sania ALBlushi
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Osaka Medical Center for Cancer and Cardiovascular Diseases , Japan Akio Tsukabe
  • - VHS medical center , Korea (South) Keuntak Roh
▶ Correct Answer as Differential Diagnosis : 7/83,  8.4%
  • - Dong-A University Hospital , Korea (South) Won Jin Choi
  • - , Korea (South) Chan Park
  • - CLCC Rennes , France nicolas gautier
  • - CHU Poitiers , France CHAN paul
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - pusan national university hospital , Korea (South) kim jeongmyeong
▶ Semi-Correct Answer : 1/83,  1.2%
  • - santosh hospital , India Pravin Mahadevappa
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