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Case 38

Anterior mediastinal mass (Liposarcoma)

A middle aged man with chest discomfort

The following chest film was obtained.

Findings

There is a large anterior mediastinal mass. There is also a small left posterior mediastinal (paraspinal) mass present. The latter is better seen on the CT image provided here (Image B, arrowed). (Note the anterior mass had been surgically removed by the time of the CT scan).

Diagnosis

Anterior mediastinal mass (Liposarcoma)

Discussion

The differential diagnosis for the anterior mediastinal mass is traditionally known as the "four T's":

• Thymoma
• Teratoma
• Thyroid goitre or tumour
• Terrible lymph nodes (eg lymphoma)

It is frequently not possible to differentiate these masses; for instance all may feature calcification. However on this film there is an additional finding of note. There is also a posterior mediastinal mass adjacent to the lower thoracic spine which focally expands the left paravertebral stripe. The presence of lymphadenopathy elsewhere increases the likelihood that this is a case of "terrible lymph nodes". The histology can not be determined from the Xrays, but further inquiry revealed a previous operation for a liposarcoma of a limb, and the appearances were due to metastatic disease.

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