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Weekly Chest CasesImaging Conference Cases

Case No : 4

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  • Age/Sex 19 / M
  • Case Title incidental chest PA abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Courtesy
S
Imaging Findings
Chest radiograph shows left paraspinal mass in lower T-spine level.

Unenhanced and enhanced CT scans show a low-attenuation mass in left paraspinal area with mild enhancement. Hyperostotic change is noted in the underlying rib.
Discussion
Neurogenic tumors originating from autonomic ganglia include ganglioneuromas, ganglioneuroblastomas and neuroblastomas.

Ganglioneuromas are benign,whereas neuroblastomas are high grade malignant tumors, common in children.

Ganglioneuroma is rare, and 60% of all patients with these tumors are younger than 20 years, most being less than 10 years of age. It most frequently occurs in the posterior mediastinum (32%) and the neck (8%).

Approximately 25% of ganglioneuromas are not truly benign but contain poorly-differentiated components including ganglioneuroblastomas and neuroblastomas, or more aggressive neurogenic tumors such as pheochromocytomas.

Characteristic CT and MR features of ganglioneuroma are
ⅰ) a well defined, oval of cresent shape mass;
ⅱ) low or intermediate CT attenuation;
ⅲ) discrete punctate calcification (20%);
ⅳ) little (80%) or no enhancement (20%) on CT;
ⅴ) inhomogenous but markedly high intensity on T2WI; and
ⅵ) lack of early enhancement with increasing enhancement on dynamic MR images.

In addition, if suspected ganglioneuromas have components which show atypical CT and MR findings, malignant or aggressive elements due to neuroblastomas, ganglioneuroblastoma or pheochromocytoma should be considered.
Reference
1. Ichikawa T, Ohtomo K, Fujimoto H, et al. Ganglioneuroma: computed tomography and magnetic
resonance features. Br J Radiol 1996;69:114-121

2. Lee JY, Lee KS, Han J, et al. Spectrum of neurogenic tumors in the thorax: CT and pathologic
findings. J Comput Assist Tomogr 1999;23:399-406

Keywords
Paravertebral, Benign tumor,
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