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Weekly Chest CasesArchive of Old Cases

Case No : 1465 Date 2025-11-17

  • Courtesy of Chan Ho Park, Young Tong Kim / Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine
  • Age/Sex 57 / F
  • Chief ComplaintDyspnea, Chest discomfort
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Primary mediastinal large B-cell lymphoma
Radiologic Findings
Fig 1. Chest radiograph shows mediastinal widening.
Fig 2-5. CT scan reveals about 15cm sized huge mass with central low density in mediastinum. One enlarged lymph nodes in right anterior diaphragmatic area. Right pleural effusion.
Brief Review
Lymphomas are responsible for approximately 15% of all primary mediastinal masses. Only 10% of lymphomas which involve the mediastinum are primary and the majority (~60%) are Hodgkin's lymphomas (HL).
Although HL and non-hodgkin’s lymphoma (NHL) may have overlapping imaging findings, HL is characterized by the presence of a discrete anterior mediastinal mass with a lobulated contour. The tumor most commonly demonstrates homogeneous soft-tissue attenuation, although large lymph node masses may demonstrate heterogeneity with complex low attenuation representing necrosis, hemorrhage, or cystic degeneration.
Lymph nodes involved in NHL tend to be larger as compared with those in HL and have a predilection for noncontiguous or hematogenous spread to thoracic and distant nodal and extranodal sites. Large B-cell lymphoma and lymphoblastic lymphoma are the most common subtypes, primarily involving the anterior mediastinum. Specifically, primary mediastinal large B-cell lymphomas usually present large and lobulated anterior mediastinal masses and occur predominantly in young adults, while also often directly invading adjacent structures. Low attenuation areas of necrosis within the mass were seen in 50% and calcification in 5%.
References
1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128 (4): 2893-909.
2. Bae YA, Lee KS. Cross-sectional evaluation of thoracic lymphoma. Radiol Clin North Am. 2008 Mar;46(2):253-64
Keywords

No. of Applicants : 75

▶ Correct Answer : 17/75,  22.7%
  • - Kyeongpook National University Hospital , Korea (South) JOHN BAEK
  • - Oita university , Japan AYUMI KAMEI
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan KENTARO KOTANI
  • - Other , Korea (South) CHAEHUN LIM
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Korea University Guro Hospital , Korea (South) SANGSEOK OH
  • - Aichi Medical University , Japan HIROAKI OKADA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 34/75,  45.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - The University of Tokyo Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Korea (South) KYUNG HYUN WOO
  • - Samsung Medical Center , Korea (South) HYUNGIN PARK
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Kyung Hee University Medical Hospital , Korea (South) INKEON YEO
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - , Korea (South) HWAJIN LEE
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
  • - , Korea (South) HYOUNG YEOB KIM
  • - Seoul National University College of Medicine , Korea (South) MINHO LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Japan MATSUNO MAI
  • - Kyoto University , Japan SHO KOYASU
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Ehime University , Japan TOMOHISA OKADA
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - , Japan HITOSHI TAKEUCHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Chonnam National University Hospital , Korea (South) JAEBONG YANG
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Semi-Correct Answer : 4/75,  5.3%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - , Turkey ARMAAN SARA
  • - , Korea (South) DONG-HO BANG
  • - GHICL , France MANUEL TOLEDANO
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