Dear Friends,
To compensate for the subtle findings in the previous case, I am presenting an obvious one in a 69-year-old man with chest pain. What would be your diagnosis before CT?
Check the images below and leave your thoughts in the comments section. The answer will be added on Friday.
1. Endothoracic goiter
2. Aortic aneurysm
3. Thymoma
4. None of the above
69-year-old man with chest pain, PA chest
69-year-old man with chest pain, lateral chest
Click here for the answer to case #79
Fig. 1
Findings: chest radiographs show a large anterior mediastinal mass displacing the trachea posteriorly. The mass does not fit the usual pattern of thymoma and it is too anterior and unilateral to think of intrathoracic goiter. Lymphoma could be a good possibility. The etiology of the mass is obvious in the enhanced CT, which shows a large saccular aneurysm of ascending aorta that is not altering the aortic contour.
Fig. 2
This case is shown to emphasise that in any mediastinal mass, we should always consider a vascular origin and perform an enhanced CT.
Final diagnosis: large saccular aneurysm of ascending aorta.
Congratulations to Genchi Bari, who was the first to suggest a vascular mass.
Teaching point: always include a vascular lesion in the differential diagnosis of mediastinal masses.
