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Weekly Chest CasesArchive of Old Cases

Case No : 989 Date 2016-10-10

  • Courtesy of Sung Shick Jou, Young Tong Kim / Soonchunhyang University Chenan Hospital
  • Age/Sex 68 / F
  • Chief ComplaintIncidental abnormality on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Schwannoma
Radiologic Findings
On the chest radiograph, a 4.5 cm smooth marginated mass with broad base on mediastinum is seen extending above the clavicle.
The mass demonstrates heterogeneous low signal intensity on T1WI and multiple fluid-fluid levels on T2WI. Post-contrast MRI shows of the mass shows enhancement of septa, mural nodule and a shell-like wall.
Brief Review
Schwannomas are most common encapsulated neurogenic tumor that have components of Antoni type A tissue (highly ordered cellular component) and Antoni type B tissue (loose myxoid component). They are usually located in paravertebral region in patients in second to fifth decade.

The schwannoma appears as sharply marginated, round, elliptical, or lobulated extrapleural mass. Abutting rib or vertebral deformity or enlargement of a neural foramen may be visible in about 50% of cases.

On CT, the tumor appear as well-demarcated round or oval low attenuation mass, that shows heterogeneous enhancement due to variable cellularity including lipidized foamy cells, cystic areas, xanthomatous and hemorrhagic changes.

On MR, the lesion demonstrates low to intermediate signal intensity on T1-weighted images and very high signal intensity on T2-weighted images. The various degenerative change makes schwannoma appear heterogeneous. The Antoni A component shows relatively low SI on T2WI whereas the Antoni B component shows very high SI on T2WI. Fluid-fluid levels could be seen due to hemorrhagic changes. The split fat sign may be seen on MRI images as a fine rind of fat around the lesion, best appreciated on T1 weighted images.
References
1. Hansell DM, Armstrong P, Lynch DA, McAdams HP. Imaging of diseases of the chest, 4th ed. Elsevier: Mosby 2005:951-958.
2. Webb WR, Higgins CB. Thoracic Imaging, Lippincott Williams & Wilkins 2005:262-266.
3. T Nakazono, CS White, F Yamaski et al. MRI
Keywords
Mediastinum, Paravertebral, Benign tumor,

No. of Applicants : 99

▶ Correct Answer : 56/99,  56.6%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - radiologist, aditya imaging centre , India vivek patel
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Shanghai Jiao Tong University Affiliated Sixth People , China Jiayin Zhang
  • - Eren Hastanesi Istanbul , Turkey Armagan Sarac
  • - Seoul national university , Korea (South) Boram Kim
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Ajou university hospital , Korea (South) DONGHYUN LEE
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - Scans world , India Philson Mukkada
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - PRINCE ALI KHAN HOSPITAL , India FAHAD LODHIA
  • - The Jikei university , Japan Taku Gomi
  • - university of montreal , Canada Andrei Gorgos I
  • - , Korea (South) BAEK YOOLIM
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - 異⑸ , Korea (South) 蹂€
  • - Gifu University Hospital , Japan Yo Kaneko
  • - 異⑸ , Korea (South) Junghwan Kim
  • - SNUH , Korea (South) TAE HYUNG KIM
  • - Chungbuk national university , Korea (South) Yong Kim
  • - chungbuk national university hospital , Korea (South) lee jung hwan
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - Kyungpook national university hospital , Korea (South) Sung Jun Moon
  • - Ajou university hospital , Korea (South)
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - Asan Medical Center , Korea (South) Chan Ho Park
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - 以‘ , Korea (South) Jang Won
  • - christian medical college , India Prateek Malik
  • - Konkuk University Medical Center , Korea (South) Yong Wonn Kwon
  • - snuh , Korea (South) Choo jiyung
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Korea university medical center, guro hospital , Korea (South) JINWOO HAN
  • - ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Private sector , Greece Vasilios Tzilas
  • - SNUH , Korea (South) Juil Park
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - Ajou University Hospital , Korea (South) Youngjin Yoo
▶ Correct Answer as Differential Diagnosis : 28/99,  28.3%
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Otsu Municipal Hospital , Japan Noriatsu Ichiba
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - NIMS,Hyderabad , India Amit Dadhania
  • - , Korea (South) Seon Park
  • - thiruvarur medical college , India arivudai nambi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - Medicheck health care , Korea (South) Chae Lim
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - CHU Poitiers , France CHAN paul
  • - Ajou University Hospital , Korea (South) Young Keun Sur
  • - ICD,MCH CALICUT , India rikhy krishnan
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - NASA SCANS , India RAKESH BHATIA
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu-chong
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
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