Chest X-Ray breakdown: dealing with an abnormal mediastinal contour скачать в хорошем качестве

Chest X-Ray breakdown: dealing with an abnormal mediastinal contour

A male in his 20s presents with fatigue. What does the X-Ray show? ——————————————————————- HODGKIN LYMPHOMA 👨🏽‍💻This X-Ray shows a mediastinal mass in a young male - by seeing the hilum overlay sign we can place the mass within the anterior mediastinum however here are signs of involvement of the middle mediastinum as well 👨🏽‍💻The 4 Ts give us a differential of an anterior mediastinal mass ▫️Thymic epithelial tumour ▫️Teratoma and germ cell tumour ▫️Thyroid goitre ▫️’Terrible’ lymphoma 👨🏽‍💻Given his age lymphoma and germ cell tumour go to the top of the list. Worth noting thymomas make up a large proportion of anterior mediastinal masses over the age of 50. Aortic aneurysm is possible although the fact we can see a normal aortic knuckle would mean the aneurysm would have to arise from the arch and take a strange shape, although not impossible 👨🏽‍💻When putting this case out on Instagram, some people saw a positive ‘cervicothoracic sign’ - when this sign is present the upper border of a lesion can be seen well above the clavicles with this thought to represent a posterior mediastinal lesion (as the anterior mediastinum ends at the clavicles). However paratracheal lesions (middle mediastinum) as we have here can be seen slightly above the clavicles so it’s possible to be caught out 👨🏽‍💻Thankfully, as happens often with Hodgkin lymphoma, there was a good response to treatment with the patient in remission years down the line ——- ☑️Patient consent obtained #theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #whitecoat #mri #xray #medical #radiography #radiologystudent #doctor #medicalstudents #interventionalradiology #chestxray #surgeon #medic #frcr #anatomy #usmle #medlife #exams #premed⁣