A 5-year-old female presented with coughing and vomiting blood. Imaging showed an oval mass in her right posterior mediastinum compressing her right lung and superior vena cava. CT and ultrasound imaging characterized the mass as well-defined, homogeneous and hypoechoic without calcification or necrosis. She was diagnosed with ganglioneuroma, a benign sympathetic ganglion tumor most common in older children.

1. Imaging Department
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Reported by Dr. Giang

2.  Name: Hoang Thi Lan Anh
 Sex: Female
 Age: 5 years old
 Dept: Out patient

3. Clinical
 Cough
 Vomitus cruentus (2 times)
 No fever
 No anemia

4. Chest Xrays
 Oval mass extending over several rib interspaces
 Right side of Dorsal Vertebras. ( D7 - D11)

5. Ultrasound
 Hypoechogenic mass superior to Right Diaphragm.

6. Chest CT Findings
(Pre C+)
 Well-defined Right posterior mediastinal mass
 Oval shape & homogenous density.
 No Calcification or necrosis intra mass

7. Chest CT Findings
(Post C+)
 Mild homogenous enhance
 Compress SVC & Right Lung.
 Rib & vertebra : not invaded.

8. Chest CT Findings
(Post C+, lung parenchyma)
 Right Lung lower lobe: compressed by mass.
 Both Lung parenchyma: normal.

9. Diagnosis
Ganglioneuroma

10. Background of Ganglioneuroma
 Terminology: Sympathetic ganglion tumors in mediastinum. 4 type:
1. Neuroblastoma: Malignant neoplasm of neural crest cells.
o Nonencapsulated
o Heterogeneous: Hemorrhage, necrosis, cystic degeneration
2. Ganglioneuroblastoma : neuroblastoma mature
o More homogeneous in between neuroblastoma and ganglioneuroma
3. Ganglioneuroma: ganlioneruroblastoma mature. (benign)
o Encapsulated; homogeneous tissue
4. Paraganglioma : Neuroendocrine tumor of chromaffin cell origin
o Highly vascular
o May produce catecholamines
 Age: Neuroblastoma < 3, Ganglioneuroblastoma 3-10, Ganglioneuroma> 10
 Location: Elongated, vertical posterior mediastinal mass (paraspinal)
 Treatment: Surgical ressection. Chemotherapy, radiationtherapy for advanced
disease.