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

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