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An Abnormal Chest x-Ray
Syed Hashmi, MD;
Bahman Parandian, MD
From the Division of Surgical Critical Care, Department of Surgery, Brigham and Women' s Hospital, Boston, Mass (Dr Hashmi); Department of Surgery, St Agnes Health Care, Baltimore, Md (Dr Parandian).
Arch Surg. 2002;137:1193-1194.
INTRODUCTION
A 51-YEAR-OLD white man with a 45-year history of smoking was noted to have an abnormality on a routine chest x-ray. He denied any history of cough, sputum production, chest pain, dyspnea, weight loss, weakness, or tuberculosis. There was no previous chest x-ray available for comparison. The patient's physical examination results were unremarkable. His chest x-ray is shown in Figure 1 and a computed tomographic (CT) scan of his chest is shown in Figure 2.
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Figure 1.
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Figure 2.
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What Is the Diagnosis?
1. Morgagni hernia
2. Right middle lobe tumor
3. Pericardial cyst
4. An anterior mediastinal mass
Answer: An Anterior Mediastinal Mass
Figure 1. Chest x-ray.
Figure 2. Computed tomographic scan of the chest. Computed tomography revealed an anterior mediastinal mass separated from the lung. The patient underwent a neck exploration and the mass was found to be a thymoma. Mediastinal tumors or cysts are grouped according to their location in the anterior, middle, or posterior mediastinum.1 The anterior mediastinum is defined as the area posterior to the sternum and anterior to the heart and great vessels. The middle mediastinum contains the heart and the pericardium, while the posterior mediastinum is posterior to the heart and anterior to the upper thoracic vertebrae. The most common lesions of the anterior mediastinum are thymomas (47%), lymphomas (22%), endocrine tumors (16%), and germ cell tumors (16%).2 Most patients with thymomas are asymptomatic on initial examination, although those with symptoms of chest pain, cough, or dyspnea are more likely to have a malignant type of thymoma.3 There is no characteristic radiographic appearance of a thymoma on chest x-ray but the CT scan can provide evidence of invasion into adjacent structures. The diagnosis is made when the mass is excised, usually through a median sternotomy.4 Thymomas are also associated with a wide variety of autoimmune abnormalities, such as myasthenia gravis, hypogammaglobulimenia, and pure red blood cell aplasia.5 The staging for a thymoma is according to clinical, anatomic, and histologic characteristics.6
AUTHOR INFORMATION
Corresponding author and reprints: Syed Hashmi, MD, Division of Surgical Critical Care, Department of Surgery, Brigham and Women' s Hospital, 75 Francis St, Boston, MA 02115 (e-mail: shashmi{at}partners.org).
REFERENCES
1. Fraser RS, Pare JP, Fraser RG, et al. The normal chest. In: Fraser RS, Pare JP, Fraser RG, et al, eds. Synopsis of Diseases of the Chest. 2nd ed. Philadelphia, Pa: WB Saunders; 1994:1-116.
2. Mullen B, Richardson JD. Primary anterior mediastinal tumors in children and adults. Ann Thoracic Surg. 1986;42:338-345.
ABSTRACT
3. Kohman LJ. Approach to the diagnosis and staging of mediastinal masses. Chest. 1993;103(suppl):328S-329S.
4. McCart JA, Gaspar L, Inculet R, Casson AG. Predictors of survival following surgical resectionof thymoma. J Surg Oncol. 1993;54:233-238.
PUBMED
5. Rosai J, Levine GD. Tumors of the thymus. In: Firminger HI, ed. Atlas of Tumor Pathology. Fasc 13. Ser 2. Washington, DC: Armed Forces of Institute of Pathology; 1976:34-212.
6. Lewis JE, Wick MR, Scheithauer BW, et al. Thymoma: a clinicopathologic review. Cancer. 1987;60:2727-2743.
FULL TEXT
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SECTION EDITOR: GRACE S. ROZYCKI, MD
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