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Findings: CT scan of the chest showed a large sharply-defined mass extending from the lower neck to the anterior superior mediastinum with coarse calcifications within the mass. It displaces the trachea to the left and posteriorly.
Diagnosis: A huge goiter with calcification.
Discussion: On unenhanced CT scans a variety of mediastinal masses contain areas of attentuation values higher than the attenuation value of the chest wall musculature. The increased attenuation may be diffuse or focal and may be a result of calcium deposition, high iodine content, or areas of acute hemorrhage.
Differential diagnosis: 1) Calcified lymph nodes due to infection such as histoplasmosis and tuberculosis, disseminated pneumocystis carinii infection. 2) Calcified lymph nodes due to Amyloidosis, 3) Calcified lymph nodes due to metastatic tumors such as bronchogenic CA, ovarian CA. 4) Primary neoplasm: Germ cell tumors, thymomas and neurogenic tumors. Calcium within a fatty mass is highly suggestive of a benign nature teratoma, calcium in lymph node of treated Hodgkin's disease. 5) Calcium in a goiter. 6) Mediastinal hematoma with calcification.
Thymoma is a rare benign neoplasm of the thymus. Most tumors are located in the anterior inferior mediastinum. Only 18% are located in the anterior superior mediastinum.
References:
Glazer HS, Molina PL, Siegel MJ. High Attenuation Mediastinal Masses on
Unenhanced CT. AJR 1991;156:45-50.
Rosado-de-Christensen M, Pugatch RD, Moran CA. Thymolipoma: Analysis of
Twen-Seven Cases. Radiology 1994;193:121.
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