| Findings: Chest X-ray:
1. Increased density and widening of superior mediastinum,
predominant over left side, nature to be determined
(figure 1).
Multidetector row CT scan of chest with pre- and post-intravenous
contrast, and with multiplanar reconstruction, maximum-intensity
projection, and 3D volume rendering: 1. A lobulated big mass with punctate calcifications (figure 2,
arrows) and mild contrast enhancement (figure 3) in bilateral
paraspinal regions of posterior mediastinum, predominant over
left side, neurogenic tumor such as thoracic neuroblastoma may
be considered until proved otherwise.
2. Suspicious spinal canal invasion by the tumor with mild erosion
of posterior surfaces of corresponding vertebral bodies in upper
thoracic spine (figure 3, red arrow).
3. Presence of mass effect of the above tumor with direct
indentation of left-sided descending aorta (figure 4 and 5,
yellow arrows) and indirect compression of left bronchus (figure
4-6, blue arrows) with significant smooth stenosis.
4. Some passive atelectasis in both lungs due to mass effect of
the tumor.
5. Small subpleural infiltration in both lower lungs, may due to
chronic inflammatory process. Impression:
1. Posterior mediastinum tumor, suspicious neurogenic tumor.
2. Suspicious tumor invasion to thoracic spinal canal.
1.5 Tesla MRI of chest (focus on thoracic spine) with
MR myelography, T2 weighted echo train spin echo, T1 weighted echo
train spin echo with and without fat saturation, MR diffusion
imaging, T2/T1 steady-state gradient echo with fat saturation,
and with intravenous gadolinium-enhancement:
1. A lobulated big long T1 and T2 mass with strong contrast
enhancement (figure 7, red arrows) and without significant
restricted water diffusibility (not showed) in bilateral
paraspinal regions of posterior mediastinum, predominant over
left side, neurogenic tumor such as thoracic neuroblastoma may
be considered until proved otherwise.
2. Presence of tumor direct invasion to T1-T5 dilated spinal canal
through bilateral neuroforamina (figure 7, yellow arrows).
Mass effect of the tumor with encasement and compression of
corresponding spinal cord (figure 8, arrows).
But no detectable signal change or contrast enhancement within
spinal cord itself.
3. Besides, tumor direct extension to midline posterior back soft
tissue and left paravertebral back muscles (figure 7, green
arrows).
4. A 1.1cm ovoid enhancing nodule in right infraspinatus muscle
over right upper back, suggesting tumor distal metastasis
(figure 9, red arrows).
5. Some small lymph nodes in bilateral axillae, may due to
chronic infection. Impression:
1. Posterior mediastinum tumor, suspicious neurogenic tumor.
2. Tumor invasion to T1-T5 spinal canal with corresponding
spinal cord compression.
3. Besides tumor direct invasion to left back muscle and distal
metastasis to right back muscle. |
080520 POSTERIOR MEDIASTINUM TUMOR, SUSPICIOUS THORACIC NEUROBLASTOMA
