Case Reports and Reviews: Open Access

Abstract 

Background: The majority of mediastinal masses occur in the anterior mediastinum. Differential diagnosis of such masses is thymoma, thyroid goiter, teratoma, or lymphoma. Anterior mediastinal masses can present as an incidental finding on radiographic studies. Thymomas are rare tumors representing about 50% of anterior mediastinal masses and about 20-30% of all mediastinal tumors. Case Description: We present a case of an 81-year male in whom chest X ray revealed mediastinal widening. The patient did not present with symptoms of mediastinal mass effect or paraneoplastic symptoms as myasthenia gravis. CT chest showed multiple large smooth lobular homogeneous fluid attenuation cystic mass in the anterior mediastinum measuring up to 15.7 cm in width, which did not appear to invade vasculature, lung, or pericardium. The patient declined to undergo an imaging guided biopsy of the mass. Hence, F- 18 FDG PET-CT imaging was performed and visualized the anterior mediastinal mass as a cystic lobulated photopenic lesion with no appreciated FDG uptake, representing a thymic cyst. Conclusions: Fifty Percent of patients with thymomas are diagnosed incidentally with chest radiography as anterior mediastinal mass. The standard diagnostic workup includes CT chest imaging, while standard management is thymectomy. However, individualized patient management on a case per case basis should be implemented. 

Keywords: Thymoma; Anterior Mediastinal Mass