대한흉부영상의학회 Weekly Chest Cases

Case No : 468 Date 2006-10-16

Courtesy of Byoung Wook Choi, MD, Jae Wook Lee, MD. / Sinchon Severance Hospital, Seoul, Korea
Age/Sex 20 / F
Chief ComplaintAbnormality in screening chest X-ray

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Diagnosis With Brief Discussion

Diagnosis: Thymolipoma
Radiologic Findings: Chest PA and lateral show an increased opacity in the left lower zone, which obliterates the interface between the left diaphragm and lung parenchyma. This feature mimics left pleural effusion. CT shows a large mass in the left anterior and inferior mediastinum, which is conforming to other structures. The mass contains fat and soft tissue densities.
Brief Review: Thymolipomas are rare benign tumors seen in children and adults, the age range being 2 to 66 with a mean in the twenties, composed of a mixture of mature fat and normal looking or involuted thymic tissue in the anterior mediastinum, mostly in the cardiophrenic angles. Individual cases have been reported in association with a variety of conditions, including myasthenia gravis, aplastic anemia, Grave’s disease and hypogammaglobulinemia. Thymolipoma can grow to a very large size before discovery. Being soft, they mold themselves to the adjacent mediastinum and diaphragm and often mimic cardiomegaly, lobar collapse, or diaphragmatic elevation. CT shows the fatty density of the mass with islands of thymus and fibrous septa running through the lesion. At MRI, there is the expected high signal of fat on T1-weighted images and there may be lower signal strands coursing through the mass representing residual fibrous stroma and/or thymic tissue. Both CT and MRI show a connection between the thymus and the tumor.
References: 1. Amstrong P. Mediastinal and hilar disorders. In Amstrong P, Wilson AG, Dee P, Hansell DM, eds. Imaging of diseases of the chest. 3rd ed. London: Mosby, 2000: 802

2. Rosado-de-Christenson ML, Pugatch RD, Moran CA, et al. Thymolipoma: analysis of 27 cases. Radiology 1994;193:121-126
Keywords: Mediastinum, Benign tumor,

No. of Applicants : 36

▶ Correct Answer : 16/36, 44.4%

- Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Institut fur Rontgendiagnostik, Helios Kliniken, Schwerin Roger Eibel
- Nanavati Hospital, Mumbai Susheel Kumar
- Maimomides Medical Center; Brooklyn, New York, USA Naomi Twersky
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Sam Anyang Hospital, Korea Jae Seung Seo
- Annecy Hospital, France Gilles Genin
- St. VincentHospital, Korea Chae-hun Lim
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Radiologie Guiton, La Rocelle, France Jean-Luc Bigot
- Incheon Sarang hospital, Korea Jung Hee Kim
- Annemasse, Polyclinique de Savoie, France Gay-Dpassier Philippe
- Pgimer, Chandigarh, India Ashish Gupta
- Doctors Hospital, Nassau, Bahamas N.B.S.Mani
- Pgimer, Chandigarh, India Ram Prakash Galwa
- China Medical University Hospital,Taiwan Jun-Jun Yeh

▶ Correct Answer as Differential Diagnosis : 3/36, 8.3%

- Nanavati Hospital, Mumbai Jayant Narang
- KEM Hospital, Mumbai, India Shilpa Sankhe
- Hopital Calmette, Chru, Lille, France Toledano Manuel

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 468 Date 2006-10-16

Discussion

No. of Applicants : 36