대한흉부영상의학회 Weekly Chest Cases

Case No : 207 Date 2001-10-15

Courtesy of Chan Sup Park, M.D., Ki Bong Yu, M.D., Seong Soo Byun, M.D. / Inha Hospital, Seongnam, Korea
Age/Sex 30 / F
Chief ComplaintChest discomfort and dyspnea since one month ago

Figure 1
Figure 2
Figure 3
Figure 4

Diagnosis With Brief Discussion

Diagnosis: Mediastinal Lymphangioma
Radiologic Findings: Chest PA and lateral views show a large homogenous opacity situated in the mediastinal area, extending from a point near the thoracic inlet down to the inferior pulmonary vein. The lateral projection shows that the mass is situated in the middle mediastinal compartments. The tracheal air column is displaced anteriorly.
CT scan at the level of the aortopulmonary window shows that the mass is of water density and has a sharp interface with contiguous lung parenchyma.
Brief Review: Mediastinal lymphangioma have two clinicopathologic forms; 1) a variety that extends from the neck into the mediastinum and usually occurs in infants (cystic hygroma) and 2) a more or less well-circumscribed variety that usually is discovered in adults and is located in the lower anterior (occasionally middle posterior) mediastinum remote from the neck. As with hemangiomas, lymphangiomas probably represent developmental anomalies rather than true neoplasm. Pathologically, the tumor consists of thin-walled, usually multilocular cysts containing numerous thin-walled vascular spaces lined by endothelial cells. The wall is composed of connective tissue with a variable amount of lymphoid tissue.
The radiographic findings are nonspecific and consist of a sharply defined, smoothly marginated mediastinal mass, which frequently displaces adjacent mediastinal structures. In one investigation of 19 adult patients, 7 tumors (37%) were located in the anterior mediastinum, 5 (26%) in the middle mediastinum, 3(16%) in the posterior mediastinum, 3(16%) in the thoracic inlet, 1 in the lung.
The most common CT appearance, seen in about 60% of cases, consists of a smoothly marginated cystic mass with homogenous water density. Multiple loculations can be seen within the mass in approximately one third. The mass can displace or surround adjacent vessels. Less common findings include foci of calcification, homogenous soft tissue density, and spiculated margins. Hemorrage results in an increase in the size of the mass and an increase in the attenuation values on CT. The findings on MR imaging in three patients were variable and nonspecific.
References: 1. Miyake H, Shiga M, Takaki H, Hata H, Onishi R, Mori H. Mediastinal lymphangiomas in adults: CT findings. J Thoracic Imaging 1996;11;83-85
2. Shaffer K, Rosando-de-Christenson ML, Patz EF, Young S, Farver CF. Thoracic lymphangiomas in adults: CT and MR imaging features. AJR 1994;162:283-289
3. Fraser and Pare's Diagnosis of diseases of the chest. Fourth edition. W.B.Saunders Company, 1999:2921-2924
Keywords: Mediastinum, Benign tumor,

No. of Applicants : 30

▶ Correct Answer : 6/30, 20.0%

- 怨
-
- CHU Nancy-Brabois, France Denis Regent
- IMSL, metz, France Eric Gaconnet
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate

▶ Semi-Correct Answer : 22/30, 73.3%

- 嫄닿뎅
- 嫄댁
- 寃쏀щ蹂瑜
- 怨
- 怨源
- 怨
- 愿댁고
- 源吏
- 遺理湲곕났
-
- 源
- 諛
- 源
-
-
-
- Dong-A University Hospital Ki-Nam Lee
- HEPLR Aubervilliers, France Alain Levy
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Seoul National University Hospital Su Kyung An
- Seoul National University Hospital Tae Jung Kim
- Sudhakar

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 207 Date 2001-10-15

Discussion

No. of Applicants : 30