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Weekly Chest CasesArchive of Old Cases

Case No : 562 Date 2008-08-04

  • Courtesy of Soo-Youn Ham, MD, Yu-Whan Oh, MD, Eun Jung Choi, MD. / Korea Univ. Medical Center, Anam Hospital, Seoul, Korea.
  • Age/Sex 28 / F
  • Chief ComplaintIncidentally detected abnormal finding in chest radiography
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Cystic Lymphangioma-mediastinum
Radiologic Findings
* Elongated non-calcified, non-enhancing mass in Rt. mediastinum, from thoracic inlet level to the diaphragm level.
* Insinuating lesion to the mediastinal spaces and partial encasement of the great vessels.
* Rt mediastinal mass; D/Dx - lymphangioma, pericardial cyst

* Multilobulated cystic mass was noted between the parietal and mediastinal pleura.
* Mild adhesion with pericardium is shown.
* Serosanguinous jelly like cystic fluid was aspirated from the mass.
* Multiple trabeculation was noted in the mass.
Brief Review
Histopathology
* Thymus, excisional biopsy; Cystic lymphangioma
* Note; CK; - D2-40; + CD31; - Alcian blue; -

* Lymphangioma has been classified into three groups:
(1) lymphangioma simplex;
(2) cavernous lymphangioma;
(3) cystic lymphangioma or cystic hygroma.
* Cystic hygroma presents as a soft tissue mass in the posterior triangle of the neck and only rarely does it extend into the mediastinum.
* Most of the cystic hygromas are not diagnosed during childhood until growing to be very large.
* Lymphangiomas are benign nonencapsulated lesions composed of sequestered noncommunicating lymphoid tissue lined by lymphatic endothelium and are thought to be caused by congenital obstruction of lymphatic drainage.
* They are subclassified by vessel size, such as the capillary, which is rare and located in subcutaneous tissue, cavernous (located about the mouth and tongue), and cystic (cystic hygromas).
* Only 3%-10% of neck lesions extend into the mediastinum. In this paper, we report a rare case of cystic hygroma with a huge dimension discussing the use of computed tomography scanning for diagnosis.
* Findings on MR imaging is a signal similar to or greater than that of muscle on T1-WI with marked increased in signal on T2-WI. However, low signal on T2-WI due to hemorrhage or fibrotic changes.
* The differential diagnosis of cystic mass includes necrotic tumors and lymph nodes (tuberculosis or metastatic nodules of solid tumors), teratomas, thymic cyst, hematomas, fluid collection, bronchogenic cysts, and pericardial cysts.
References
1. Bossert T, Gummert JF, Mohr FW. Giant cystic lymphangioma of the mediastinum. Eur J Cardiothorac Surg. 2002;21:340
2. Brown LR, Reiman HM, Rosenow EC III, Gloviczki PM, Divertie MB. Intrathoracic lymphangioma. Mayo Clin Proc. 1986;61:882?92
3. Oshikiri T, Morikawa T, Jinushi E, Kawakami Y, Katoh H. Five cases of the lymphangioma of the mediastinum in adult. Ann Thorac Cardiovasc Surg. 2001;7(2):130?35
4. Nakazato Y, Ohno Y, Nakata Y, Yamaguchi H, Hazato N, Nagasawa S, Yokoyama M, Yamada T. Cystic lymphangioma of the mediastinum. Am Heart J. 1995;129:406?09
5. Yildirim E, Dural K, Kaplan T, Sakinci U. Cystic lymphangioma: report of two atypical cases. Int Cardiov & Thorac Surg. 2004;3:63-65
6. Charrauau L, Parrens M, Jougon J, et al. Mediastinal lymphangioma in adults: CT and MR imaging features. Eur Radiol. 2000;10:1310-1304
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 81

▶ Correct Answer : 10/81,  12.3%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Osaka University , Japan Osamu Honda
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Kasturba Medical College Manipal , India Paresh Desai
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - EKH-Berlin , Germany Michael Weber
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
▶ Correct Answer as Differential Diagnosis : 18/81,  22.2%
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - apollo hospitals , India harish bhambore
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Tri-Service General Hospital , Taiwan Tsun-Hou Chang
  • - jiangsu province hospital , China yuan doctor
  • - CHRU Lille , France Benjamin DAMAREY
  • - chp st martin , France Mariotte benoit
  • - radiology department ANNECY , France gilles GENIN
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
▶ Semi-Correct Answer : 37/81,  45.7%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - partner, aditya imaging centre , India vivek patel
  • - hospital Sao Paulo , Brazil israel missrie
  • - Al-Hada Armed Hospital , Saudi Arabia ahmed Fathi Eid
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - OSWAL CANCER HOSP. , India vishal garg
  • - Trakya University School of Medicine Deparment of Radiology , Turkey Devrim Urut
  • - nirman hitech diagnostic centre , India minal seth
  • - institute of thoracic medicine , India siva raja
  • - National Taiwan University Hospital, Yun-lin Branch , Taiwan Chin-Chung Shu
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - Cheongshim international medical center , Korea (South) Yang Hae Jum
  • - KMC,Manipal , India satish maddukuri
  • - CHU , France Julien Balique
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Assam medical college, INDIA , India karunakaran M
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - korea univ. hospital, radiology department , Korea (South) choo yung
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India , India Bankim Amin
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - INRAD - Faculty of Medicine, University of S Paulo , Brazil Natanael Ahn
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - MD PG Resident, PIMS,LONI, MAHARASHTRA, INDIA , India Sushant Bhadane
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - kims,narkatpally , India k bhaskar
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - Apollo Hospital, Ahmedabad. , India Sandip Shah.
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - Pe d , France Fabrice Bing
  • - All India Institute of medical sciences , India Justin Moses
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - All India Institute of Medical Sciences , India puneet kochar
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