Anne Knisely, MS4 Diagnostic Radiology elective

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Presentation transcript:

Anne Knisely, MS4 Diagnostic Radiology elective Case Report Anne Knisely, MS4 Diagnostic Radiology elective MRN 2590078

DC, 12 y.o. F Presented to the ED via EMS with left shoulder, thigh, and rib pain after she rode her bicycle into a concrete wall w/o a helmet ?LOC, mild HA, no emesis, was moving all extremities after landing in the grass per parents PMH: seasonal allergies, constipation PE: significant only for mild abrasions and ecchymosis over left lateral thigh In ED: FAST, CT head, XR elbow/knee/radius/ulna/shoulder/femur, CXR, CTA chest CT head w/o contrast- no ICH, mass, skull fx

Symmetric widening of the superior mediastinum - could be secondary to presence of thymic tissue, projectional (AP supine film), vascular injury, mediastinal mass/lymphoma

Extensive multi-station mediastinal and hilar LAD concerning for lymphoma

R main pulm artery is compressed due to mass effect from perihilar LAD

ED Course Consult to peds heme/onc Discussion with parents re: concern for lymphoma Labs H/H 11.2/32.6 Rest of CBC, CMP, Mg, phos, PT, PTT, LDH, uric acid- unremarkable Ambulatory referral to peds heme/onc clinic No B sx!!

Diagnosis/Follow up Diagnosis: Mediastinal& hilar lymphadenopathy/mass 1st clinic visit: Imaging concerning for possible lymphoma, although no worrisome sx, history, labs, or exam findings PET: “FDG avid mediastinal and hilar lymphadenopathy” 2nd clinic visit: fatigue, submandibular adenopathy CT-guided FNA: “Atypical lymphocytes” Flow Cytometry: “normal thymic tissue” Initial ED visit- 5/14 1st clinic visit- 5/17 PET, 2nd clinic visit- 5/25 CT-guided FNA- 5/30

Radiographic Features and Ddx: Mediastinal Mass in a Child Anterior Mediastinum (most common location) Solid: prominent/ectopic thymus, thymoma, thymic carcinoma, lymphoma, teratoma Fatty: lipoma, thymolipoma Cystic: thymic cyst, lymphatic malformation Middle Mediastinum Vascular anomalies Nonvascular lesions: congenital foregut duplication cyst, bronchogenic cyst, esophageal cyst, neurenteric cyst LAD: primary neoplasm (lymphoma), metastasis, infection Posterior Mediastinum (usually neurogenic) Sympathetic ganglion tumors: neuroblastoma, ganglioneuroblastoma, ganglioneuroma Nerve sheath tumors: schwannoma, neurofibroma, malignant peripheral nerve sheath tumor

References Friedmann A. (2008) Evaluation and Management of Lymphadenopathy in Children. Pediatrics in Review 29(2): 53-60. Ranganath SH et al. (2012) Mediastinal Masses in Children. American Journal of Roentgenology 198(3): W197-216.