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