Maryam Zeba’s Post

A female in her 30s presents with fatigue and weight loss. What does the Chest X-Ray show and what is the differential diagnosis? ————————————————- ANTERIOR MEDIASTINAL MASS 👨🏽💻The key to a good differential diagnosis in this case is spotting that you can see the hilar vessels through the mass 👨🏽💻Felson (a legend of chest imaging) first described the ‘hilar overlay sign’ although its initial use was to differentiate an enlarged heart from a mass at the hilum. The principle can be applied here however - as we can see the hilar vessels we know the mass is unlikely to sit at the hilum. Primary lung cancers like to involve the hilum so now this becomes less likely 👨🏽💻Lesions which show the hilum overlay sign usually sit within the anterior mediastinum. To confirm this a lateral X-Ray could help. The next step is then usually CT which as well as confirming an anterior mass, can help with: ▫️excluding other nodes as you may see with lymphoma ▫️looking for fat density within the mass which you may see with germ cell tumour ▫️looking for continuity with the thyroid gland which you will see with enlarged goitre ▫️looking for pleural or pericardial nodules which you may see with thymic tumours 👨🏽💻As there were further nodes higher up in the mediastinum not visible on X-Ray, lymphoma became the most likely differential (this was confirmed with biopsy) 🔻I hope this provides some help the next time you see an anterior mediastinal mass on X-Ray ▫️@theradiologistpage ———- ✅Patient consent obtained #theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #xray #medical #radiography #pleuraleffusion #doctor #medicalstudents #surgeon #frcr #chestxray

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Male in his 70s presents with breathlessness. What does the X-Ray show?