대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1262 Date 2021-12-29

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  • Courtesy of Kyung Hee Lee / Bundang Seoul National University Hospital
  • Age/Sex 41 / M
  • Chief ComplaintIncidental finding on routine health check
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Multilocular thymic cyst
Radiologic Findings
Fig 1. There is a lobulating mass-like opacity at the left hila, showing hilum overlay sign, which indicates that the mass is either anterior or posterior to the hila.
Fig 2~5. There are multiple mediastinal cysts with enhancing wall and nodular portions at the anterior mediastinum.
Fig 6-7. PET/CT images show multiple cystic mass-like lesions with heterogeneous hypermeabolic portion in the anterior mediastinum (SUV max up to 6.3).
Brief Review
The patient underwent thymectomy and the lesion was pathologically confirmed as a multilocular thymic cyst. The nodular lesions with PET uptake on imaging corresponded to the cholesterol granuloma accompanied with inflammation and hemorrhage on pathology.

Multilocular thymic cysts are acquired lesions of the thymus and are most likely caused by an inflammatory process. They can occur in association with thymic neoplasia, including thymoma and thymic carcinoma, Hodgkin's disease, and seminoma. In cases of suspected multilocular thymic cyst, it is of vital importance that the histopathologic specimen be carefully inspected to exclude coexisting neoplasia

CT findings include well-defined, heterogeneously-enhancing, unilocular or multilocular cystic masses arising at the location of the thymus, often with calcification or soft-tissue attenuation components. The radiologic differential diagnosis for such lesions of the anterior mediastinum includes cystic teratoma, lymphangioma, hemangioma, cystic degeneration of seminoma, Hodgkin's disease, and thymoma. Because CT cannot be used to reliably distinguish neoplastic from non-neoplastic soft-tissue components, complete surgical resection and careful histopathologic examination is recommended in all patients with suspected multilocular thymic cyst.
Please refer to
Case 1072, Case 362,
References
1. YW Choi, HP McAdams, SC Jeon, EK Hong, YH Kim, JG Im et al. Idiopathic multilocular thymic cyst: CT features with clinical and histopathologic correlation. AJR 2001;177(4):881-5.
2. J Kim, YW Choi, SC Jeon, J Heo, C Park, SS Paik et al. Multilocular Thymic Cyst Associated with Mediastinal Teratoma: A Case Repo J Korean Radiol Soc 2007;56:51-54
Keywords

No. of Applicants : 99

▶ Correct Answer : 37/99,  37.4%
  • - , Japan HIROAKI ARAKAWA
  • - Korea University Guro Hospital , Korea (South) SEOKYOUNG LEE
  • - , Japan JUN KANZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , China FANG YING GEN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - , United States HIROAKI TAKAHASHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KANA TANAKA
  • - , Japan KAZUMA TERAUCHI
  • - National Center for Global Health and Medicine , Japan TOMOKI IMOKAWA
  • - , Korea (South) NAEUN OH
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 9/99,  9.1%
  • - Osaka University , Japan AKINORI HATA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Korea (South) PARK JONGMIN
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , Korea (South) YEONG UK HWANG
  • - , Japan MIDORI UENO
  • - Osaka city university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - , Japan SOTA MASUOKA
▶ Semi-Correct Answer : 3/99,  3.0%
  • - Az Osp Santa Maria Terni , Italy ANGELO CARLONI
  • - , Italy PAOLO BALDASSARI
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
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