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Weekly Chest CasesArchive of Old Cases

Case No : 1452 Date 2025-08-18

  • Courtesy of Ji-yeon Han, Seok Jin Choi / Inje University Busan Paik Hospital
  • Age/Sex 54 / M
  • Chief ComplaintIncidentally found abnormality
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Ganglioneuroma
Radiologic Findings
Fig 1. Chest PA (Posteroanterior) radiograph reveals a well-defined soft tissue density with an obtuse angle in the right upper thorax, extending to the upper level of the clavicle. This suggests a negative cervicothoracic sign (Fig. 1).
Fig 2. Non-enhanced and enhanced CT scans (Fig. 2) demonstrate a hypodense, less avidly enhancing, elongated mass in the right posterior mediastinum.
Fig 3. Chest MRI shows a T2 hyperintense cystic mass with central hypointensity. On T1-weighted imaging, the mass exhibits an intermediate signal with rim-like central enhancement. No diffusion restriction is noted on the b800 ADC image.
Brief Review
The mass was successfully resected via video-assisted thoracoscopy. Intraoperative images demonstrated the mass's extrapleural location. Histopathological analysis confirmed the diagnosis of ganglioneuroma.
CT findings in this case are typical of ganglioneuroma, characterized by an oval, homogeneously hypodense mass in the paravertebral region, frequently observed in younger patients. Ganglioneuromas consist of nerve fibers, Schwann cells, mature ganglion cells, and a mucous matrix. Diagnosis relies on identifying ganglion cells within the tumor.
When a significant proportion of the tumor consists of mucous matrix, CT imaging reveals hypodensity, while T2-weighted MRI shows hyperintensity. Notably, curved or linear hypointense signals scattered among the hyperintense areas on T2-weighted imaging produce a whorled appearance.
Due to the abundant mucous matrix in ganglioneuromas, cellular components exhibit enhancement while the mucous matrix remains non-enhanced. Delayed enhancement occurs due to the obstructed perfusion of contrast agents by the mucus. In this case, gadolinium-enhanced MRI revealed intratumoral linear mild enhancement. ADC values are typically higher for ganglioneuromas compared to neuroblastomas, reflecting their benign behavior.
References
Guan YB, Zhang WD, Zeng QS, Chen GQ, He JX. CT and MRI findings of thoracic ganglioneuroma. Br J Radiol. 2012 Aug;85(1016):e365-72.
Keywords

No. of Applicants : 73

▶ Correct Answer : 21/73,  28.8%
  • - Funabashi General Hospital , Japan MANABU AKIMOTO
  • - Oita university , Japan AYUMI KAMEI
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - QATIF CENTRAL HOSPITAL , Saudi Arabia HANI M ALSALAM
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Oita university , Japan NORITAKA KAMEI
  • - Kyoto City Hospital , Japan AKIHIKO MINAMI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Kobe Children , Japan SHUHEI NORIMOTO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - University of Yamanashi , Japan KOJIRO ONOHARA
▶ Correct Answer as Differential Diagnosis : 20/73,  27.4%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - , Italy PAOLO BALDASSARI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Kyoto University , Japan SHO KOYASU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Chonbuk National University Hospital , Korea (South) SUBIN LEE
  • - Ehime University , Japan TOMOHISA OKADA
  • - Nara medical university , Japan HIROHIDE WATANABE
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
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