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Weekly Chest CasesArchive of Old Cases

Case No : 1072 Date 2018-05-14

  • Courtesy of Ji Won Lee, MD. / Pusan National University Hospital
  • Age/Sex 75 / M
  • Chief ComplaintIncidental abnormality on a chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Multilocular thymic cyst
Radiologic Findings
Fig 1. Chest PA depicts a large mass-like opacity at the hila, showing hilum overlay sign, which indicates that the mass is either anterior or posterior to the hila. In addition, the descending aorta is clearly seen, indicating that the mass is within the anterior mediastinum.
Fig 2. Mediastinal window setting of the chest CT scan shows a 11cm sized multilocular cystic mass in the anterior mediastinum. Septal enhancement was seen within the mass.
Brief Review
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.
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
anterior mediastinum, Thymus, Thymic Cyst,

No. of Applicants : 107

▶ Correct Answer : 39/107,  36.4%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Seoul National University Hospital , Korea (South) JAE WON CHOI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - Azienda Ospedaliera Universitaria Integrata di Verona , Italy GIAN ALBERTO SOARDI
  • - The Jikei university , Japan TAKU GOMI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Intermed Hospital , Mongolia KHULAN KHURELSUKH
  • - Okayama University Hospital , Japan KAZUAKI MUNETOMO
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - , United States MAANSI P
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - eskisehir devlet hastanesi , Turkey MURAT SAHIN
  • - , Japan NAOMI YUASA
  • - Maimonides Medical Center , United States NAOMI TWERSKY
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan YUMI MAEHARA
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 11/107,  10.3%
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Other , Korea (South) SEONGSU KANG
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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