Image Of The Day 2: Lymphoma Muhamad Na’im B. Ab Razak (MD USM)This 46 years old gentleman who is a chronic smoker and alcoholic and with underlyinghistory of Ex PTB completed treatment presented with non specific chest pain and cough.Otherwise he denied any history of fever, shortness of breath, constitutional symptoms and noreduce effort tolerance.On clinical examination noted that there are no clubbing, no wasting of small muscle, noresting or intentional tremor, no cynosis, no ptosis and no hyperthyroidism symptoms.However, chest examination reveals trachea shifting to the right, bulging of left mediastinum,reduce left chest wall movement, reduce air entry over left chest and dullness on percussionup to left upper zone. Otherwise, reduce vocal resonance and fremitus.The chest X Ray shows 1) Trachea shifted to the right, 2) Heart shifted to the right, 3) Widemediastinum with anterior mediastinal mass and hazinnes of the left hemithorax up to theupper zone.
In Image of the Day 1, [Link] i put a case of Dissecting aortic aneurysm withhaemothorax secondary to the leaking. Today’s image would broaden up our mind to thinkabout non vascular cause of enlarged mediastinal mass. The differential diagnosis would beHodgkin’s lymphoma, non hodgkin’s lymphoma, Thyroid mass, Teratoma and Tumors of thethymus (cyst or thymoma).Other rarer cases of widened mediastinum reported in case studies include venous aneurysm,mediastinal lipomatosis, descending necrotizing mediastinitis, spontaneous rupture ofcommon carotid artery, malignant fibrous histiocytoma, traumatic extravasation ofcerebrospinal fluid and others.Lateral chest film may help to differentiate the origin of the mass. However, with the advanceof radiological modalities, CT scan and MRI are found to be more superior than plainradiograph. Radiological intervention would alse very helpful for diagnostic purposeespecially in doing biopsy.