Wk 5, Case 42 - Review

EXAM: CT Chest with contrast
CLINICAL INDICATION: Pleuritic chest pain. Fever.
FINDINGS:
SUPPORT DEVICES: None.
VASCULAR: Opacification of the pulmonary tree is adequate. In the pulmonary arteries are normal in size without filling defect to suggest pulmonary embolism. The thoracic aorta is normal in course and caliber without evidence of dissection or aneurysm.
MEDIASTINUM: There is a large soft tissue mass within the anterior mediastinum measuring 8.5 x 4.4 cm (image 77, series 4). There is no significant mass effect on the aorta, airway or pulmonary artery. The heart and pericardium are normal.
The thyroid is normal.
LYMPH NODES: No abnormality.
AIRWAYS/LUNGS/PLEURA: The airways are patent. Small right pleural effusion versus pleural thickening. No left pleural effusion. No pneumothorax or pleural effusion. Bibasilar dependent subsegmental atelectasis.
VISUALIZED ABDOMEN: No acute abnormality.
BONES/SOFT TISSUES: Abnormal heterogeneous moth eaten appearance of the left clavicle with nonspecific linear lucency (image 2-8, series 3). No acute abnormality.

IMPRESSION:
1. Anterior mediastinal mass which may represent thymic tumor or lymphoma. Given impression #2 below, favoring lymphoma.
Correlate with any outside imaging or tissue sampling as clinically indicated.
2. Heterogeneous/moth eaten appearance through the distal left clavicle with associated nondisplaced fracture. Findings may represent pathologic fracture.
Correlate with point tenderness.