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Le KDR, Wang AJ, Haycock S, Fink K, Lee SJ. Upfront Thoracic Magnetic Resonance Imaging for the Evaluation of Thymic Lesions to Reduce Non-Therapeutic Diagnostic Thymectomy: A Narrative Review. Healthcare (Basel) 2024; 12:2036. [PMID: 39451451 PMCID: PMC11507284 DOI: 10.3390/healthcare12202036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/12/2024] [Accepted: 10/13/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Thymic pathologies represent the most common lesions of the anterior mediastinum. They may be classified as malignant or benign. Current diagnostic pathways recommend an initial assessment with computed tomography (CT) imaging to delineate potentially malignant thymic lesions. Despite this, high rates of non-therapeutic thymectomy continue to be observed. This carries with it significant anaesthetic, operative, and post-operative risks, in addition to healthcare costs. Consequently, there is a growing interest in magnetic resonance imaging (MRI) as a primary diagnostic modality for lesions of the anterior mediastinum. This narrative review outlines the current approaches to the evaluation of thymic lesions, with a discussion of the strengths and limitations of CT and MRI imaging modalities. It also evaluates the current discourse on the use of upfront MRI for thymic and anterior mediastinal lesion assessment. Methods: A narrative review was performed following a search on the Medline database. Articles that were evaluated had explored the role of MRI on the evaluation of thymic and anterior mediastinal lesions. Results: Current work-up for thymic and anterior mediastinal lesions are highly variable and centre around the use of CT. Upfront MRI demonstrates a similar accuracy to CT for various thymic and anterior mediastinal pathologies; however, the efforts to integrate this approach into routine practice remain in their infancy, with no standardised guidelines that exist. Conclusions: This narrative review demonstrates that there is a paucity of evidence relating to the sensitivity and specificity of MRI compared to CT for thymic lesion analysis and their subsequent relationship with non-therapeutic thymectomy. Future prospective trials to assess the role of MRI in thymic lesion determination are required to understand whether MRI can more accurately characterise these lesions to reduce non-therapeutic thymectomy. Additionally, further research efforts are required to characterise best-practice methods for integrating MRI into diagnostic pathways for these lesions in a cost-effective and resource-conscious manner.
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Affiliation(s)
- Khang Duy Ricky Le
- Department of Surgery, Northeast Health Wangaratta, Wangaratta, VIC 3677, Australia
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
- Geelong Clinical School, Deakin University, Geelong, VIC 3220, Australia
| | - Annie Jiao Wang
- Department of Surgery, Northeast Health Wangaratta, Wangaratta, VIC 3677, Australia
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
| | - Shasha Haycock
- Department of Surgery, Northeast Health Wangaratta, Wangaratta, VIC 3677, Australia
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Kaylah Fink
- Department of Surgery, Northeast Health Wangaratta, Wangaratta, VIC 3677, Australia
| | - Su Jin Lee
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
- Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia
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Zhao W, Zhang S, Qi X, Teng S, Sun L, Zeng H. Pediatric mediastinal lymphatic malformation: misdiagnosis analysis and literature review. BMC Pediatr 2024; 24:617. [PMID: 39342201 PMCID: PMC11438015 DOI: 10.1186/s12887-024-05069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Mediastinal cystic lymphatic malformation (MCLM) in children is prone to misdiagnosis as cystic teratoma. We compared the clinical and radiologic features between the two diseases and performed a cross-comparison with previous research on adult cases. This study aims to identify characteristic pediatric manifestations to improve diagnostic accuracy. METHODS A retrospective study of clinical and radiologic data was conducted on 12 MCLM and 20 cases of cystic teratomas confirmed by pathology or intervention biopsy. Clinical characters and radiology features (mass location and morphology, density, component, secondary complication) were recorded and compared. We reviewed clinical studies on MCLM published in the past decades, analyzing radiological differences and comparing pediatric MCLM cases at our hospital with those in the literature. RESULTS Group comparison in pediatrics between MCLM and cystic teratomas: There were significant age differences (p = 0.036), shape (p = 0.003), CT difference value (p < 0.001), CT difference ratio (p < 0.001), calcification (p < 0.001), fat (p < 0.001), and typing (p < 0.001) between the two diseases. An analysis of literature data on MCLM cases involved 16 studies. CONCLUSION The absence of internal fat or irregular morphology, along with a minimal CT difference value, may suggest the diagnosis of MCLM. In pediatric cases, anterior mediastinal diseases tend to extend toward the neck, and the presence of the thymus can complicate the component analysis, thereby increasing the risk of misdiagnosis. Clinical diagnosis and differential diagnosis of pediatric MCLM rely heavily on imaging evaluation.
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Affiliation(s)
- Wen Zhao
- Shantou University Medical College, Shantou University, 22 Xinling Road, Jinping District, Shantou, 515041, China
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, China
| | - Siqi Zhang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Xinxin Qi
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, China
- China Medical University, No.77 Puhe Road, Shenbei New District, Shenyang, 110122, China
| | - Songyu Teng
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, China
- China Medical University, No.77 Puhe Road, Shenbei New District, Shenyang, 110122, China
| | - Longwei Sun
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, China
| | - Hongwu Zeng
- Shantou University Medical College, Shantou University, 22 Xinling Road, Jinping District, Shantou, 515041, China.
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, China.
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 PMCID: PMC10301342 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliero Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliero Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L’Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L’Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliero Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
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Bennett-Caso C, Srinath A, de la Roza G, Stock H, Damron TA. Extramedullary Hematopoiesis Adjacent to Vertebral Fracture in a Patient with Pernicious Anemia: Support for a Mechanical Extrusion Mechanism. JBJS Case Connect 2023; 13:01709767-202306000-00028. [PMID: 37172112 DOI: 10.2106/jbjs.cc.22.00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE A 68-year-old woman presented with a paraspinal mass of indeterminate imaging characteristics. Workup and computed tomography-guided Fine Needle Aspiration (FNA) aspiration revealed extramedullary hematopoiesis (EMH) adjacent to a prior compression fracture in the setting of pernicious anemia. CONCLUSION The combination of findings suggests a possible relationship of the compression fracture and the EMH because of traumatic extravasation of marrow contents, with the patient's underlying anemia possibly providing an underlying predisposition to EMH.
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Affiliation(s)
| | - Arjun Srinath
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Gustavo de la Roza
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Harlan Stock
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York
| | - Timothy A Damron
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, New York
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Taka M, Kobayashi S, Mizutomi K, Inoue D, Takamatsu S, Gabata T, Matsumoto I, Ikeda H, Kobayashi T, Minato H, Abo H. Diagnostic approach for mediastinal masses with radiopathological correlation. Eur J Radiol 2023; 162:110767. [PMID: 36921376 DOI: 10.1016/j.ejrad.2023.110767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses. METHOD We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented. RESULTS Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated. CONCLUSIONS Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.
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Affiliation(s)
- Masashi Taka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Kaori Mizutomi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Shigeyuki Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8530, Japan.
| | - Takeshi Kobayashi
- Department of Radiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hitoshi Abo
- Department of Radiology, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama City, Toyama 930-8550, Japan.
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Schön F, Hoffmann RT, Kaiser DPO. [Lesions of the paravertebral mediastinum]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:180-186. [PMID: 36627368 DOI: 10.1007/s00117-022-01109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Lesions of the paravertebral mediastinum are rare, and knowledge of possible differential diagnoses is essential for clinical practice. OBJECTIVE/METHODS To review common lesions of the paravertebral mediastinum. RESULTS The paravertebral mediastinum mainly includes fatty tissue and neurogenic structures. Imaging is commonly performed using computed tomography (CT) and magnetic resonance imaging (MRI). Neurogenic tumors are the most common lesions of the paravertebral mediastinum. Other pathologies include extramedullary hematopoiesis, lipomatous, lymphogenic, inflammatory, and cystic lesions. Moreover, also diaphragmatic hernias, vascular and esophageal pathologies may be found in the paravertebral mediastinum.
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Affiliation(s)
- F Schön
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Dresden, Deutschland.
| | - R T Hoffmann
- Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Dresden, Deutschland
| | - D P O Kaiser
- Institut und Poliklinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Dresden, Deutschland
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7
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Piran M, Nolting JK, Körperich H, Zabel R, Scholtz S, Friedrichs KP, Hakim-Meibodi K, Danebrock RI, Burchert W, Paluszkiewicz L. Clinically atypical abdominal manifestation of the lipoma localized in the right atrium: "Invagination hypothesis" revisited. Echocardiography 2022; 39:1462-1465. [PMID: 36266720 DOI: 10.1111/echo.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022] Open
Abstract
Cardiac lipomas are the second most common cardiac tumors. They are usually asymptomatic and diagnosed as incidental findings. We describe a 71-year-old patient with a tumor in the right atrium. In echocardiography and MRI scan, the diagnosis of a cardiac lipoma was suspected. Moreover, MRI demonstrated continuity of pericardial fat and the tumor in the right atrium by infolding of the atrial wall and epicardial adipose tissue in the space between the atrial walls, which might be a hint for the Waterstone groove hypothesis. An operative resection was performed which confirmed the suspected diagnosis.
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Affiliation(s)
- Misagh Piran
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Julia Kathinka Nolting
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Reinhard Zabel
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kai Peter Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Raihanatou Ina Danebrock
- Institut für Pathologie, Johannes Wesling Klinikum Minden, Ruhr-Universität Bochum, Minden, Deutschland
| | - Wolfgang Burchert
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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8
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Strange CD, Ahuja J, Shroff GS, Truong MT, Marom EM. Imaging Evaluation of Thymoma and Thymic Carcinoma. Front Oncol 2022; 11:810419. [PMID: 35047412 PMCID: PMC8762255 DOI: 10.3389/fonc.2021.810419] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023] Open
Abstract
Imaging is integral in the management of patients with thymoma and thymic carcinoma. At initial diagnosis and staging, imaging provides the clinical extent of local invasion as well as distant metastases to stratify patients for therapy and to determine prognosis. Following various modalities of therapy, imaging serves to assess treatment response and detect recurrent disease. While imaging findings overlap, a variety of CT, MRI, and PET/CT characteristics can help differentiate thymoma and thymic carcinoma, with new CT and MRI techniques currently under evaluation showing potential.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Edith M Marom
- Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
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9
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Valente T, Bocchini G, Rea G, Paccone M, Vitale G, Sica G. First Computed Tomography Evidence of Pulmonary Cavitated Lipoma: Diagnosis and Management. Indian J Radiol Imaging 2021; 31:758-760. [PMID: 34790332 PMCID: PMC8590547 DOI: 10.1055/s-0041-1735922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lipomas are the most common form of benign soft tissue tumors in humans, occurring infrequently in visceral organs. Pulmonary lipomas are seen rarely and can occur such as an endobronchial (80%) or peripheral parenchymal (20%) lesion. Less than 10 cases of lung peripheral lipoma are described in literature, none cavitated. We report the clinical case of a 51-year-old emphysematous smoker man with a peripheral intrapulmonary middle-lobe cavitating lipoma, revealed during a routine chest X-ray for emphysema, subsequently confirmed by high-resolution computed tomography (HRCT) and positron emission tomography (PET)-CT. Some hypotheses are made about the origin of cavitation. Biopsy and surgery were not done due to the fully benign nodular features at imaging. The nodule was unchanged till 2 years, last follow-up with low-dose HRCT. It is probably useful to choose a conservative approach with a follow-up, if there is a high suspicion of benignity.
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Affiliation(s)
- Tullio Valente
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Giorgio Bocchini
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Gaetano Rea
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Marianna Paccone
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Vitale
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
| | - Giacomo Sica
- Section of General Radiology, Department of Diagnostic Imaging, Azienda dei Colli, Monaldi Hospital, Naples, Italy
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10
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Malik B, Abdelazeem B, Ghatol A. Pleural lipoma: when to intervene. BMJ Case Rep 2021; 14:14/4/e243175. [PMID: 33853823 PMCID: PMC8054074 DOI: 10.1136/bcr-2021-243175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bilal Malik
- Internal Medicine, McLaren Health Care Corp/ Michigan State University (MSU), Flint, Michigan, USA
| | - Basel Abdelazeem
- Internal Medicine, McLaren Health Care Corp/ Michigan State University (MSU), Flint, Michigan, USA
| | - Abhijeet Ghatol
- Pulmonary and Critical Care Medicine, McLaren Health Care Corp/ Michigan State University (MSU), Flint, Michigan, USA
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11
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Tao S, Bai Y, Zhou X, Zhao J, Yang H, Zhang S, Wang J. In Vitro Fermentation Characteristics for Different Ratios of Soluble to Insoluble Dietary Fiber by Fresh Fecal Microbiota from Growing Pigs. ACS OMEGA 2019; 4:15158-15167. [PMID: 31552361 PMCID: PMC6751720 DOI: 10.1021/acsomega.9b01849] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
This study was conducted to explore the in vitro fermentation characteristics for different ratios of soluble to insoluble dietary fiber in pig fecal microbiota. The fermentation substrates consisted of inulin and a non-starch polysaccharide mixture and were divided into five groups according to different soluble dietary fiber (SDF) to insoluble dietary fiber (IDF) ratios (SDF 25, 50, 75, and 100%). With the increased SDF ratio, the total gas production increased, and the pH in the substrate decreased as the fermentation proceeded. The concentrations of lactic acid, formic acid, and acetic acid increased in the high SDF ratio group, whereas the concentrations of propionic acid and butyric acid increased in the low SDF ratio group. The genera Clostridium_sensu_stricto_1, Ruminococcaceae_NK4A214_group, Christensenellaceae_R-7_group, and Rikenellaceae_RC9_gut_group were enriched in the high SDF ratio group. Correlation analysis indicated that these differential bacteria had the potential to degrade polysaccharides. These results revealed that high SDF ratios could stimulate the proliferation of fibrolytic bacteria, which in turn degrade fibers to produce organic acids and monosaccharides. Collectively, these findings add to our understanding of the mechanisms responsible for interaction between SDF and intestinal microbiota and provide new ideas for the rational use of dietary fiber.
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12
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Suhail FA, El Shafei MM, El.Sabaa BM, Risk AM, Safe SHA. An infrequent cause of total lung collapse: Endobronchial lipoma. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2014.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fahd Ahmed Suhail
- Department of Radiology (Division of Chest Imaging), Alex. University Medical Centre, Egypt
| | | | | | - Adel Mohamed Risk
- Department of Radiology (Division of Chest Imaging), Alex. University Medical Centre, Egypt
| | - Shadya Halmy Abou Safe
- Department of Radiology (Division of Chest Imaging), Alex. University Medical Centre, Egypt
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Broncano J, Alvarado-Benavides AM, Bhalla S, Álvarez-Kindelan A, Raptis CA, Luna A. Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum. World J Radiol 2019; 11:27-45. [PMID: 30949298 PMCID: PMC6441936 DOI: 10.4329/wjr.v11.i3.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
In the new era of functional magnetic resonance imaging (MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, “do not touch lesions” could be identified with the associated impact in the management of those patients. One of the hot-spots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival. Therefore, in this review we will analyze the current functional imaging techniques available (18F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Hospital San Juan de Dios, Health Time, Cordoba 14012, Spain
| | - Ana María Alvarado-Benavides
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Sanjeev Bhalla
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | | | - Constantine A Raptis
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Antonio Luna
- MR imaging Unit, Clínica Las Nieves, Jaen 23007, Spain
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14
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Abstract
The mediastinum contains vital vascular and nonvascular structures and organs, and a wide variety of abnormalities may arise from this region of the thorax. Although mediastinal masses may be initially detected on chest radiography, cross-sectional imaging plays an important role in the identification and evaluation of mediastinal lesions, enabling the formulation of focused differential diagnoses and ultimately guiding management. Computed tomography (CT) is considered the imaging modality of choice for evaluating most mediastinal masses; however, the role of magnetic resonance (MR) imaging continues to expand, as it is superior to CT in differentiating between cystic and solid masses, identifying cystic and solid components within complex lesions, and distinguishing thymic hyperplasia and normal thymus from thymic epithelial neoplasms and other neoplasms. In addition, it facilitates the staging and restaging of patients with thymic epithelial neoplasms and other tumors that cannot undergo contrast-enhanced CT imaging due to severe contrast allergy and/or impaired renal function. As division of the mediastinum into specific compartments is beneficial for diagnostic and treatment planning purposes and facilitates communication between clinicians in a multidisciplinary setting, a new classification model based on cross-sectional imaging has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. In this article, we describe the role of MR imaging in the evaluation of mediastinal masses in conjunction with the new mediastinal compartment classification system introduced by ITMIG.
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Affiliation(s)
- Brett W Carter
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, Rosado-de-Christenson ML, Marom EM. ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses. Radiographics 2017; 37:413-436. [PMID: 28129068 DOI: 10.1148/rg.2017160095] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Division of the mediastinum into specific compartments is beneficial for a number of reasons, including generation of a focused differential diagnosis for mediastinal masses identified on imaging examinations, assistance in planning for biopsies and surgical procedures, and facilitation of communication between clinicians in a multidisciplinary setting. Several classification schemes for the mediastinum have been created and used to varying degrees in clinical practice. Most radiology classifications have been based on arbitrary landmarks outlined on the lateral chest radiograph. A new scheme based on cross-sectional imaging, principally multidetector computed tomography (CT), has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. This clinical division scheme defines unique prevascular, visceral, and paravertebral compartments based on boundaries delineated by specific anatomic structures at multidetector CT. This new definition plays an important role in identification and characterization of mediastinal abnormalities, which, although uncommon and encompassing a wide variety of entities, can often be diagnosed with confidence based on location and imaging features alone. In other scenarios, a diagnosis may be suggested when radiologic features are combined with specific clinical information. In this article, the authors present the new multidetector CT-based classification of mediastinal compartments introduced by ITMIG and a structured approach to imaging evaluation of mediastinal abnormalities. ©RSNA, 2017.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Rachna Madan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Myrna C Godoy
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
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Occhipinti M, Heidinger BH, Franquet E, Eisenberg RL, Bankier AA. Imaging the posterior mediastinum: a multimodality approach. Diagn Interv Radiol 2016; 21:293-306. [PMID: 25993732 DOI: 10.5152/dir.2014.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information.
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Affiliation(s)
- Mariaelena Occhipinti
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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17
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Suut S, Al-Ani Z, Allen C, Rajiah P, Durr-E-Sabih, Al-Harbi A, Al-Jahdali H, Khan AN. Pictorial essay of radiological features of benign intrathoracic masses. Ann Thorac Med 2015; 10:231-42. [PMID: 26664560 PMCID: PMC4652288 DOI: 10.4103/1817-1737.160365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
With increased exposure of patients to routine imaging, incidental benign intrathoracic masses are frequently recognized. Most have classical imaging features, which are pathognomonic for their benignity. The aim of this pictorial review is to educate the reader of radiological features of several types of intrathoracic masses. The masses are categorized based on their location/origin and are grouped into parenchymal, pleural, mediastinal, or bronchial. Thoracic wall masses that invade the thorax such as neurofibromas and lipomas are included as they may mimic intrathoracic masses. All examples are illustrated and include pulmonary hamartoma, pleural fibroma, sarcoidosis, bronchial carcinoid, and bronchoceles together with a variety of mediastinal cysts on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Sometimes a multimodality approach would be needed to confirm the diagnosis in atypical cases. The study would include the incorporation of radionuclide studies and relevant discussion in a multidisciplinary setting.
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Affiliation(s)
- Syahminan Suut
- Consultant Radiologist, Radiology Department, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsal, Manchester M8 6RB, United Kingdom
| | - Zeid Al-Ani
- Specialist Registrar in Radiology, North Manchester General Hospital, Delaunays Road M8 5RB, Manchester, United Kingdom
| | - Carolyn Allen
- Clinical Director, Acute Pennine NHS Trust, Crumpsal, Manchester M8 6RB, United Kingdom
| | - Prabhakar Rajiah
- Assistant Professor, Cardiothoracic Imaging, Radiology Department, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, United States
| | - Durr-E-Sabih
- Director, Multan Institute of Nuclear Medicine and Radiotherapy, Nishtar Hospital, Multan 60000, Pakistan
| | - Abdullah Al-Harbi
- Assistant Professor, Pulmonary Division, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Assistant Professor, Pulmonary Division, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Nawaz Khan
- Consultant Radiologist, Radiology Department, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsal, Manchester M8 6RB, United Kingdom
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Abstract
Mediastinal masses are relatively uncommon, yet include a large variety of entities. Some tumors can be diagnosed with confidence based on imaging alone; others when a typical appearance is combined with the right clinical presentation. A structured approach for radiologists is presented to facilitate evaluation of patients with anterior mediastinal tumors. The approach focuses first on the more common tumors and on imaging features that strongly suggest a particular diagnosis. Discussion with the clinician can be very helpful in formulating a presumptive diagnosis. This article also discusses that confirmatory imaging or biopsy tests are most beneficial in particular situations.
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19
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Pruente R, Restrepo CS, Ocazionez D, Suby-Long T, Vargas D. Fatty lesions in and around the heart: a pictorial review. Br J Radiol 2015; 88:20150157. [PMID: 25950727 DOI: 10.1259/bjr.20150157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A wide variety of fat-containing entities occur in and near the heart. These findings are often encountered by radiologists and may be incidental or the reason for the patient's clinical presentation. Cross-sectional imaging helps to characterize the extent of these lesions and to formulate a differential diagnosis, which varies by lesion location, imaging features and patient demographics. The purpose of this pictorial essay is to familiarize radiologists with these fat-containing lesions and to help avoid misdiagnosis and errors in management. This pictorial review will discuss the normal fatty structures in and around the heart. A range of common and uncommon fat-containing lesions will then be reviewed based upon lesion location.
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Affiliation(s)
- R Pruente
- 1 University of Colorado School of Medicine, Department of Radiology, Aurora, CO, USA
| | - C S Restrepo
- 2 University of Texas Health Science Center, Department of Radiology, San Antonio, TX, USA
| | - D Ocazionez
- University of Texas Health Science Center, Houston, TX, USA
| | - T Suby-Long
- 1 University of Colorado School of Medicine, Department of Radiology, Aurora, CO, USA
| | - D Vargas
- 1 University of Colorado School of Medicine, Department of Radiology, Aurora, CO, USA
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20
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Sureka B, Agarwal Y. Giant mediastinal thymolipoma mimicking teratoma. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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21
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Obstrucción bronquial crónica causada por un lipoma endobronquial. RADIOLOGIA 2014; 56:91-3. [DOI: 10.1016/j.rx.2012.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 03/24/2012] [Accepted: 03/28/2012] [Indexed: 11/16/2022]
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Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L. A diagnostic approach to the mediastinal masses. Insights Imaging 2012; 4:29-52. [PMID: 23225215 PMCID: PMC3579993 DOI: 10.1007/s13244-012-0201-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 10/23/2012] [Accepted: 10/31/2012] [Indexed: 01/12/2023] Open
Abstract
Background Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis. Methods Radiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another. Results Tissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases. Conclusion Familiarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment. Teaching Points • CT and MRI are important for the diagnosis of mediastinal masses. • The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses. • Symptomatology and patient age affect the likelihood of malignancy.
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Affiliation(s)
- Sergi Juanpere
- Department of Diagnostic Radiology, Hospital Sant Pau i Santa Tecla, 14 Rambla Vella, 43003, Tarragona, Spain,
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Infrascapular abnormalities: location-specific fat-containing chest wall lesions. AJR Am J Roentgenol 2012; 198:W510-1; author reply W511. [PMID: 22528936 DOI: 10.2214/ajr.11.8167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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