Findings case 1: there is an interruption of the para-esophageal line (A, arrows) by a rounded middle mediastinal opacity (A, red arrow). In a young asymptomatic patient, the most probable diagnosis is an esophageal duplication cyst.
Unenhanced coronal CT confirms the mass (B, red arrow) adjacent to esophageal air (B, arrow). The density of the mas is similar to the mediastinal soft tissues, which is not uncommon in duplication cysts. To confirm the diagnosis an MRI was ordered. Unfortunately, this week in Spain has two holidays (very few of us are working) and the MRI will not be done until next week.
Diagnosis: probable mediastinal duplication cyst, pending MRI.
Findings case 2: there is moderate scoliosis and sclerotic vertebras are visible through the mediastinal shadow (A, arrows).
Coronal and sagittal CT (B, C) confirms the findings. Review of the clinical history discovered that the patient had a previous carcinoma of the breast.
Diagnosis: sclerotic vertebral metastasis from breast carcinoma.
Congratulations to Coffee, who was the first to diagnose both cases.
Teaching point: these are two nice cases, seen the same week, in which the abnormalities were inside the mediastinal shadow and could be easily missed (as a matter of fact, two of you did).
case 1:
-There is fracture at right mid clavicle with displacement, might be non union fracture.
-There is suspect focal bulging contour at distal part of szygoesophageal recess , possibly enlarged node, esophageal lesion such as foregut maformation.
case 2:
– There is suspected increaed density of the vertebra at lower thoracic spine, quasionable for ivory vertebra which could be metastasis, lymphoma, paget disease, infection such as TB
Hello.
In case one I can see right clavicular fracture. Also the right heart border is ill defined (pectus excavatum?).
In case two there is right thoracic scoliosis and asymmetry of the mammary shadows, smaller on the left. I also think there is osteosclerosis of two lower thoracic vertebrae, and texture heterogeneity of two middle vertebral bodies (mets?).
Hi, professor,
Case 1: there is a bulging of azygoesophaegal line, that could correspond to mediastinal lesion.
Case 2: increased density of thoracic vertebras. Metastasis?
Good night! I am late!!
In case one we can not see the right cardiac margin and there are a verticalizatiin of the anterior costal arcs because of pectus excavatum.
In case two there is a scoliosis with right dorsal convexity and there is an increased density in some dorsal vertebral bodies. The right breast is bigger than the left one so I am thinking about breast cancer with vertebral mtx.
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