Clinical:
- A 63 years old lady
- Underlying DM and HPT
- Feeling unwell with cough for one month
- Recently associated with shortness of breath
- Loss of weight 7 kg in two months
Radiographic findings:
- There is widened mediastinum
- No mediastinal shift, trachea is centrally located
- Homogenous opacity at right mid and lower zones with obliteration of right cardiac margin and right hemidiaphragm
- Left costophrenic angle is not blunted
- No pneumothorax
- The aerated lung fields are normal.
- No lung nodule or mass seen.
Radiology diagnosis: Widened mediastinum.
Discussion:
- Mediastinal widening is a common finding on the chest radiograph.
- It is defined as mediastinum measurement more than 8 cm at the level of the aortic knob on a frontal chest radiograph
- The differential diagnosis include vascular anomalies, traumatic aortic injury, lung lesions, mediastinal lymphadenopathies, mediastinal lipomatosis, mediastinal masses or due to technical factors such as poor inspiration and lordotic position.
Progress of patient:
- CT thorax done showing enlarged mediastinal nodes.
- Biopsy done, HPE came back as Diffuse large B cell lymphoma
- Patient was started on chemotherapy
CT scan findings:
- There are multiple matted mediastinal nodes of varying sizes seen in the superior and middle mediastinum.
- These nodes are encasing the brachiocephalic trunk, superior vena cava, trachea, both main bronchus, both pulmonary arteries and right pulmonary veins.
- Mass effect and compression are seen to the right main bronchus, left main bronchus, right and left pulmonary arteries and left atrium. However, no filling defect or thrombosis within these great vessels and heart chambers to suggest thrombosis.
- Collapsed-onsolidations of the right lung involving both the upper and lower lobes.
- Moderate right pleural effusion seen.
- Associated right hydropneumothorax too.
