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