Presentation
Leukocytosis discovered at wellness examination (27,000).
Patient Data
There is a large soft tissue opacity mass in the cranial mediastinum. The mass is superimposed on the cardiac silhouette on the lateral projections, and silhouettes with the cranial border on the ventrodorsal projection. The cardiac silhouette is displaced caudally. No abnormalities are seen in the pulmonary parenchyma. The musculoskeletal structures are normal.
Case Discussion
Lymphocytic-rich thymoma was diagnosed on cytology after ultrasound-guided fine needle aspirate of the mass. Thymomas tend to wrap around the heart so that there is a double density sign on some projections, such as on the right lateral projection in this case. The heart stays centrally located but is often displaced caudally.
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