Presentation
Presents with cough and vomiting for one month.
Patient Data
There is a large mass effect in the cranial thorax, with elevation of the trachea. The cranial mediastinum is widened on the dorsoventral projection. The lung lobes are retracted and there are visible fissure lines. There is alveolar pattern visible in the ventral aspect of the right cranial lung lobe on the left lateral projection which has rounded margins. The cardiac silhouette is difficult to evaluate but appears normal in size on the dorsoventral projection. There is mild widening of the mainstem bronchi. On a lateral radiograph of the neck, there is mild soft tissue swelling ventral to the larynx. The right 5th rib has an old fracture and callus formation.
Case Discussion
The cranial mediastinal mass was aspirated with ultrasound guidance. The cytologic diagnosis was high grade lymphoblastic lymphoma. There was also enlargement of the mandibular and tracheobronchial lymph nodes secondary to multicentric lymphoma.
Differential diagnosis
- Cranial mediastinal mass - lymphoma, thymoma, (cyst, abscess)
- Pleural effusion - neoplastic, transudate, exudate, hemorrhage
- Alveolar pattern - pulmonary mass, pneumonia, atelectasis
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