UMEM Educational Pearls

Title: What's the diagnosis? Case submitted by Dr. Jennifer Guyther

Category: Visual Diagnosis

Posted: 6/23/2013 by Haney Mallemat, MD (Updated: 6/24/2013)
Click here to contact Haney Mallemat, MD

Question

Name three differential diagnoses based on the CXR below.

Answer

The diagnosis in this case is Non-Hodgkin lymphoma, but read below for more differentials.

Mediastinal Masses

The mediastinum is subdivided into the regions shown below. Here are some differential diagnoses based on region.

Anterior / Superior Mediastinum

Superior vena cava syndrome
Ascending Aortic aneurysm
Lymphoma
Thyroid tumor
Parathyroid tumor
Thymic masses / tumors
Germ-Cell tumor
Metastatic disease

Middle Mediastinum

Lymphadenopathy
Metastatic Disease
Lymphoma
Developmental cysts
Pericardial effusion
Foregut duplication
Bronchogenic cyst
Vascular enlargement
Aortic aneurysm

Posterior Mediastinum

Neurogenic tumors
- Peripheral nerves
- Sympathetic ganglia
- Paraganglionic tissue
Esophageal tumors
Carcinoma
Diverticula
Diaphragmatic (Bochdalek's) hernia

Congratulations to all the graduating residents, especially our own at the University of Maryland. I wish you all the best as you start your phenomenal careers!

References

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)