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Weekly Chest CasesArchive of Old Cases

Case No : 383 Date 2005-02-26

  • Courtesy of Gong-Yong Jin, M.D. / Chonjbuk University Hospital, Jeonju Korea, Seoul, Korea
  • Age/Sex 13 / F
  • Chief ComplaintIncidental abnormality on chest radiograph
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Cystic Lymphangioma
Radiologic Findings
Chest radiographs show a large homogenous opacity in the left cardiac border.

Contrast-enhanced CT scans show cystic mass abutting to pericardium and peripheral enhancing nodules. Cystic mass has very thin wall with a small calcification.


Differential diagnosis: Dermoid cyst, pericardial cyst

Pathology: thin walled cystic mass with lymphoid infiltration
Brief Review
Cystic mediastinal lymphangiomas are rare benign slow-growing tumor. They are focal mass like proliferations of lymphatic tissue. The cystic spaces are typically filled with proteinaceous fluid. Most occur in the neck and axilla, but 10% extend into the mediastinum and 1% occurs only the mediastinum. This tumor is frequently discovered incidentally on chest X-ray films. Roentgen findings are not specific. Although CT scan provides helpful information about the size, density, and site of the cysts, it cannot establish a precise diagnosis concerning its nature. They manifest on CT as smoothly marginated multicystic masses, the cyst wall variably enhance following administration of intravenous contrast material. There is no evidence of invasion to the neighboring structures and no calcification is seen within the lesions. Also, CT will show well-circumscribed and uniform low density lesions. Attenuation values in CT scan cannot be considered conclusive for diagnosis in all cases, on the non contrast scan, attenuation varied between -49 to +27 UH, there was no contrast enhancement. Unusual CT features include calcification, spiculated margin, and homogeneous soft tissue attenuation. Complete removal of the cyst is the treatment of choice, and allows precise diagnosis on histological examination. However, surgical excision is sometimes difficult, due to the size and extension of the cysts, infiltrating mediastinal planes, enveloping great vessels, and displacing mediastinal organs without invasion. The difficulty of completely eradicating certain cysts explains cases of insidious progression with compressive recurrence
References
1. Icard P, Le Rochais JP, Galateau F, Jehan A, Martel B, Brun J, Evrard C. Cystic lymphangioma of the mediastinum, Apropos of 3 cases, review of the literature. Ann Chir 1998;52(7):629-34. Review. French.

2. Jahn C, Schmutz G, Wihlm JM, Chazelet C, Roeslin N, Hannequin F. Cystic lymphangioma of the mediastinum. Radiologic data apropos of 7 cases. J Radiol. 1987 Feb;68(2):89-96. French.
Keywords
Pericardium, Mediastinum, Benign tumor,

No. of Applicants : 36

▶ Correct Answer : 6/36,  16.7%
  • - CH Metz Nancy, France Blondel Manuel
  • - CHU Besancon, France Sebastien Aubry
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Hospital de la Marina Baixa. Villajoyosa. Spain Carlos F. Munoz-Nunez
  • - Sweida National Hospital, Syria Marwan Al Chami
▶ Semi-Correct Answer : 7/36,  19.4%
  • - Annecy Hospital, France Gilles Genin
  • - CIM Saint Dizier, France JC Leclerc
  • - Good Gang-An Hospital, Korea Sang Hee Lee
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Max Hospital, Delhi, India Vickrant Malhotra
  • - Seoul National University Hospital, Korea Seung Hong Choi
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
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