Presentation
Chest pain and breathlessness.
Patient Data
Abnormal lobulated anterior mediastinal contour with hilum overlay sign. A focal opacity in the left cardiophrenic angle is noted as well.
Lobulated homogenous nodal masses involving enlarged mediastinal, bilateral internal mammary, bilateral supraclavicular, left axillary and pericardial nodal masses with no vascular invasion. Splenic hypodense focal lesions are noted as well.
Fused PET-CT images show avid uptake of 18F-FDG within the enlarged mediastinal, bilateral internal mammary, bilateral supraclavicular, left axillary and pericardial nodal masses. Similar avid uptake is also seen in the spleen.
Case Discussion
Given the very extensive nodal involvement and splenic lesion, lymphoma is almost certainly the diagnosis in this case.
Differential diagnosis of an anterior mediastinal mass in children includes:
lymphoma
germ cell tumor
thymoma, thymic hyperplasia and thymic cyst
pleuropericardial cyst
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