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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 120 Date 2000-02-12

  • Courtesy of Eil-Seong Lee, M.D. / Han-gang Sacred Heart Hospital, Seoul, Korea
  • Age/Sex 45 / M
  • Chief ComplaintRoutine check-up for evaluation of acute renal failure
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Diagnosis With Brief Discussion

Diagnosis
Schwannoma of Right Vagus Nerve
Radiologic Findings
Sharply marginated right side mediastinal mass is seen on chest radiograph.
Enhanced chest CT scans show inhomogeneous low attenuation mass with enhancing septa and wall. The mass compresses and displaces trachea and right side bronchi.
Lung window setting scan shows suspicious endobronchial component confusing diagnosis.
Bilateral pleural effusions and pulmonary edema result from acute renal failure.

A bronchoscopic examination showed slit-like narrowing of right side tracheobronchial tree due to extrinsic compression without endobronchial lesion.
Pathology specimen showed spindle cell tumor with myxoid component.
Brief Review
Neurilemmomas (Schwannomas) are solitary, encapsulated tumors and consist of a population of Schwann cell, with variable amount of reticulin fiber, but do not contain nerve tissue or collagen fiber.
Tumors are characterized by the presence of two cellular patterns: a highly ordered cellular component (Antoni type A tissue) and a loose myxoid component (Antoni type B tissue). They are usually found in the posterior mediastinum. They may be unusually located along the vagus or phrenic nerve.
Right vagus nerve descends along the innominate artery and the trachea, passes behind the azygos arch and the root of the right lung, and spread out on the esophageal wall.
References
1. Dabir RP, Piccione W Jr, Kittle CF. Intrathoracic tumors of the vagus nerve. Ann Thorac Surg 1990;50:494-497
2. Heitmiller RF, Labos JD, Lipsett PA. Vagal schwannoma. Ann Thorac Surg 1990;50:811-813
3. Cohen LM, Schwartz AM, Rockoff SD. Benign schwannomas: pathologic basis for CT
inhomogeneities. AJR 1986;147:141-143
4. Lee JY, Lee KS, Han JH, Yoon HK et al. Spectrum of neurogenic tumors in the thorax:
CT and pathologic findings. JCAT 1999;23(3):399-406
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 25

▶ Correct Answer : 4/25,  16.0%
  • -
  • -
  • - Hospital General Universitario de Alicante Spain Juan Arenas
  • - Seoul National University Hospital Seong Ho Park
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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