Hello friends,
this is a case of a patient with chronic disease.
I am showing you two CT images and, as usual, hope to read your comments.
Click here for the answer
Comment: The CT shows an anterior mediastinal mass/nodule that enhances almost as much as the aorta. The mass has a central calcification (red arrow). In this case I have included a sagittal CT image with bone window settings that shows diffuse bony changes in the spine produced by Hyperparathyroidism. This is the clue to the case.
Hypervascular mediastinal masses are most commonly Thymomas, but other causes are adenopathies from hypervascular tumours, Thyroid tumours, Castleman disease, and paragangliomas.
Solution: Primary Hyperparathyroidism with Ectopic parathyroid adenoma
Teaching points:
- Always look for additional findings that may give you the clue in the diagnosis
- Remember that high contrast uptake may help in the differential diagnosis of mediastinal tumours.
Ap diameter ofchest increased – COPD with bronchiectasis changes
Diffuse sclerotic bone and mediastinal lymphnodes. I think about lymphoma or leukemia. Unsure
keep looking and linking the findings.
Hipeevascular mediastinal adenopaty with sclerotic Bonet lesiones, I thick about Castleman disease
B/L honeycombing, increased AP diameter of the chest with dilated airways B/L, most likely representing bronchiectasis. On the lateral view, can’t help but noticing lesions at multiple vertebral levels. Mets?
Guillermo is partly right but why should this patient have the bone findings?
i would say parathyroid mediastinal mass with osseous hyperparathyroidien signs (excuse my bad english).
Has the patient have chronic renal failure? (osteodystrophy)
Mediastinal lymphadenopathy..
Timoma
Thanks for sharing this intersting case, is the patient had sestamibi test, becuase i think it is very difficult to call it only by CT.
Thanks