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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 51 Date 1998-10-17

  • Courtesy of Mi-Young Kim, M.D. / Sejong General Hospital
  • Age/Sex 14 / F
  • Chief Complaintlower neck swelling with swallowing difficulty for one month
  • Figure 1
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Chest PA

Diagnosis With Brief Discussion

Diagnosis
Ruptured Mediastinal Teratoma
Radiologic Findings
Brief Review
Most common primary germ-cell tumors in the mediastinum are cystic teratomas containing ectodermal, mesodermal, and endodermal derivatives. The presence of thick-walled cysts and fat or calcific densities is highly suggestive of mediastinal teratomas on CT. These tumors rarely rupture into the adjacent structures, such as the pleural space, pericardium, lung parenchyma, or tracheobronchial tree. Proteolytic or digestive enzymes derived from the tumor have been proposed as the cause of tumoral rupture. When the tumor is ruptured, these enzymes can cause inflammation and necrosis of adjacent organs. Prompt treatment of ruptured tumors is necessary because acute respiratory distress can develop. In addition, surgical management of ruptured tumors often is more complicated than that of unruptured tumors because internal components of the teratoma leak into the thoracic cavity, causing inflammation and adhesion. Therefore, preoperative diagnosis of ruptured teratoma is important for deciding the appropriate time for surgery and the plan of surgical approach.
Patients with mediastinal teratomas are usually asymptomatic (up to 53%). Severe symptoms (chest pain, dyspnea, or hemoptysis) were more commonly found in ruptured than in unruptured tumors. All ruptured mediastinal teratomas had a tendency to display inhomogeneity of the internal component, whereas 90% of unruptured masses showed homogenous densities of internal components in each compartment of the mass. Ancillary CT findings (such as a fat-containing mass, consolidation, or atelectasis in the adjacent lung) are important for detecting rupture in the mediastinal teratomas, although associated compressive atelectasis and pneumonitis in the adjacent lung also could be caused by large mass size. Pleural effusion was one of the most common ancillary CT findings (57%) in ruptured mediastinal teratomas. Pericardial effusion, especially in-patients with a teratoma adhering to the pericardium, also appeared to suggest rupture of the tumor into the pericardium.
References
Choi SJ, Lee JS, Song KS, Lim TH. Mediastinal teratoma: CT differentiation of ruptured and unruptured tumors. AJR 1998;171:591-597
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 14

▶ Correct Answer : 18/14,  128.6%
  • - Northwestern Memorial Hospital, Chicago, IL. USA Mitchell J. Kline
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▶ Semi-Correct Answer : 4/14,  28.6%
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