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Mediastinal diffuse large B‐cell lymphoma (DLBC) may manifest in different presentations including systemic symptoms and local mass symptoms. We report two cases of diffuse large B‐cell lymphoma presenting with pulmonary artery compression symptoms. The first case is of a 38‐year‐old Asian man which mimicked pulmonary embolism, and the second one is of a 27‐year‐old Asian woman who presented with fainting and respiratory symptoms due to local mass effect. Both cases were significantly improved after treatment. Local mass effect symptoms may be the first clinical presentation in DLBC lymphoma and should not be overlooked. [ABSTRACT FROM AUTHOR]

Mediastinal myelolipoma is a rare condition and has no obvious symptoms. In the past 20 years, some clinical cases have been documented. However, the literature has not systematically summarized its imaging features. The aim of this paper is to present a case of right posterior mediastinal myelolipoma and to review and summarize its imaging features. Twenty-six articles were included in our study, which included a total of 26 patients and 33 lesions; 90.9% of the lesions were located in the mediastinum at the level from the 8th thoracic vertebral body to the thoracic 12th vertebral body. Among the cases with unilateral mediastinum, 68.4% of the cases were located in the right posterior mediastinum. Bilateral lesions accounted for almost one-fourth of all lesions. After contrast medium was injected, 93.9% of the lesions had mild to moderate enhancement; 84.8% of the lesions contained fat density; and 75.8%, 69.7%, 87.9%, and 75.8% of the lesions showed clear boundary, regular shape, heterogeneity and were encapsulated, respectively. Only 12.1% of the lesions contained calcification. An inhomogeneous mass in the right posterior mediastinum near the spine, including fat density, is the predominant imaging marker of most mediastinal myelolipomas. [ABSTRACT FROM AUTHOR]

Mediastinal neurofibroma, a rare complication of Neurofibromatosis type 1, (NF1), rarely mimics tuberculosis. We report the case of a 12-year old boywho presented at a health establishment during infancy with clinical and roentgenographic features suggestive of pulmonary tuberculosis for received antituberculosis drug therapy. This time, he presented with hoarseness, left ptosis, posterior neck gibbus and dermal nodules. Radiograph and computed tomography (CT) of the chest showed a left cervicomediastinal tumour extending to the right superior mediastinum. At thoracotomy, a globular tumour measuring 10x7x6 cm and arising from the left vagus nerve was resected with a segment of the nerve. The cervical extension and a rim encroaching on the left brachial plexus were spared to minimize post-operative morbidity. The histopathological diagnosis was neurofibroma. Although neurofibroma originating from the vagus nerve has been reported before, this, to our knowledge, is the first reported case from the middle-belt of Nigeria. Since vagal neurofibroma can manifest earlier than cutaneous neurofibroma in patients with NF1 and mimicother chest lesions, clinicians should endeavour to investigate suspicious infantile chest lesions with other modalities in addition to chest radiography.

Abstract Mediastinal myelolipoma is a rare condition and has no obvious symptoms. In the past 20 years, some clinical cases have been documented. However, the literature has not systematically summarized its imaging features. The aim of this paper is to present a case of right posterior mediastinal myelolipoma and to review and summarize its imaging features. Twenty-six articles were included in our study, which included a total of 26 patients and 33 lesions; 90.9% of the lesions were located in the mediastinum at the level from the 8th thoracic vertebral body to the thoracic 12th vertebral body. Among the cases with unilateral mediastinum, 68.4% of the cases were located in the right posterior mediastinum. Bilateral lesions accounted for almost one-fourth of all lesions. After contrast medium was injected, 93.9% of the lesions had mild to moderate enhancement; 84.8% of the lesions contained fat density; and 75.8%, 69.7%, 87.9%, and 75.8% of the lesions showed clear boundary, regular shape, heterogeneity and were encapsulated, respectively. Only 12.1% of the lesions contained calcification. An inhomogeneous mass in the right posterior mediastinum near the spine, including fat density, is the predominant imaging marker of most mediastinal myelolipomas.

Background and purpose: Preoperative risk categorization of thymoma is useful for treatment decisions but remains challenging. This study focused on training radiomics models using contrast-enhanced computed tomography (CECT) images for thymoma risk categorization and validating the model's performance, reliability and generalizability in a relatively large cohort. Methods: This retrospective cohort study analyzed the clinical data of thymoma patients (Masaoka Koga Ⅰ-Ⅲ) who underwent thymectomy surgery at the Affiliated Chest Hospital of Shanghai Jiao Tong University School of Medicine from January 2008 to December 2017. The cohort was divided into a training group (80%) and a test group (20%) using stratified random selection. The gold standard for histologic types was based on surgically resected specimens. Low-risk histologic types included A, AB and B1. High-risk histologic types included B2 and B3. Radiomics features were extracted from manually segmented regions of interest on preoperative CECT images. Interobserver correlation and least absolute shrinkage and selection operator (LASSO) regression were used for feature selection. Model performance metrics included area under the curve (AUC) of receiver operating characteristic (ROC) curve, sensitivity and specificity. Clinical characteristics were added to the combined model. Results: A total of 478 patients (mean age 51.3±12.3 years, 48.1% was male) were included. The AUC of the clinical model, the CECT-based model, and the model using both clinical and CECT features on the test set were 0.666, 0.831 and 0.850, respectively. The best performing model had a sensitivity of 0.829 and a specificity of 0.764. Conclusion: CECT-based radiomics models showed good performance in risk categorization of thymomas.

Abstract Mediastinal diffuse large B‐cell lymphoma (DLBC) may manifest in different presentations including systemic symptoms and local mass symptoms. We report two cases of diffuse large B‐cell lymphoma presenting with pulmonary artery compression symptoms. The first case is of a 38‐year‐old Asian man which mimicked pulmonary embolism, and the second one is of a 27‐year‐old Asian woman who presented with fainting and respiratory symptoms due to local mass effect. Both cases were significantly improved after treatment. Local mass effect symptoms may be the first clinical presentation in DLBC lymphoma and should not be overlooked.

Fibrosing mediastinitis, also known as sclerosing mediastinitis, is an uncommon condition marked by abnormal proliferation of fibrous tissue in the mediastinum. This condition may accrue either as an idiopathic condition or as a complication of an underlying disease process. Its pathogenesis remains unknown. However, most reported cases are incriminating abnormal immune-mediated hypersensitivity responses to Histoplasma infection. Other rare causes include tuberculosis, blastomycosis, and an idiopathic form that may be associated with other miscellaneous conditions. CT and MR imaging play a vital role in the diagnosis and management of this disease. We present a rare case of fibrosing mediastinitis as a late complication of tuberculosis in a 34-year-old man with a prior history of mediastinal tuberculosis, mimicking initially a neoplastic mediastinal process. We will describe this clinical case in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.

Wenjie Wei,* Renrui Luo,* Zhikui Chen, Jianbin He Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Huaihua, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianbin He, Department of Respiratory and Critical Care Medicine, Hunan University of Medicine General Hospital, Jinxi South Road 144, Hecheng District, Huaihua, 418000, People’s Republic of China, Email hjb0919@aliyun.comAbstract: In the available reports on clinical medicine, the infection sites of Mycobacterium porcinum include wounds, bone marrow, respiratory tract, and catheters. A 61-year-old woman was admitted to our hospital; her hilar and mediastinal lymph nodes were found to be enlarged during health examination, but there was no specific discomfort. Initially, she had undergone a mediastinal lymph node biopsy and pathology, but the diagnosis was not confirmed. However, 16S rRNA gene sequencing revealed M. porcinum infection of hilar and mediastinal lymph nodes. Subsequently, she was treated with clarithromycin, amikacin, imipenem, and tigecycline. After 2 months, chest computed tomography showed a significant reduction in lymph nodes. M. porcinum infection was considered to be the cause of disease.Keywords: Mycobacterium porcinum, hilar, mediastinal, lymph nodes, infection

Pulmonary artery intimal sarcomas are rare, malignant tumors often associated with poor prognoses. These highly lethal tumors are difficult to distinguish given their nonspecific symptoms and challenging imaging interpretations, often being misdiagnosed as acute or chronic pulmonary embolisms, tumor emboli, or mediastinal masses. Given the poor survival rate associated with this malignancy and surgical resection is the absolute choice of treatment, early and accurate diagnoses are essential. In this article, we report the case of a 78-year-old female who was diagnosed with a pulmonary artery intimal sarcoma. We focus on optimizing diagnosis and management through the application of radiological imaging modalities, specifically computed tomography angiography scans.

Abstract Primary mediastinal choriocarcinoma, also known as non‐pregnant choriocarcinoma, is a rare malignancy unrelated to pregnancy, with a higher incidence in males. And primary mediastinal choriocarcinoma is mostly associated with organ and lymph node metastasis, with rapid progression and poor prognosis. Here, we report an extremely rare case of the primary anterior mediastinal choriocarcinoma that occurred in an 18‐year‐old man with multiple metastases of the lung and brain.

Background: The present study evaluated purified protein derivative (PPD) changes based on mediastinal lymph node density. Methods: This cross-sectional observational study was performed on 130 patients who were referred to Valiasr and Amir Al-Momenin Hospitals in Arak, Iran for a CT scan for non-infectious and non-tumor reasons. The gender of the patients was recorded, and they then underwent non-contrast CT, and their mediastinal lymph node density was measured and recorded based on the Hounsfield units. Patients were evaluated for changes in the tuberculin test. The induration diameter obtained from the tuberculin test was recorded for each individual. Data analysis was then carried out using SPSS software ver. 20. Results: There was a positive correlation between mediastinal lymph node density and tuberculin test induration diameter, so larger induration diameter in the tuberculin test results in increasing lymph node density result (r = 0.416, P < 0.001). There was a negative correlation between mediastinal lymph node density and age, i.e., mediastinal lymph node density decreased with increasing age (P< 0.001, r =-0.616). Lymph node density was higher in men than in women (P = 0.022). Conclusions: There is a positive correlation between the mediastinal lymph node density and the tuberculin test induration diameter, and the tuberculin test induration diameter increases with increasing lymph node density. There is a negative correlation between the mediastinal lymph node density and age, i.e., the mediastinal lymph node density decreases with increasing age. Lymph node density was also higher in men than in women. Therefore, the results can help ensure an earlier diagnosis of pulmonary tuberculosis, and measuring the mediastinal lymph node density is recommended. [ABSTRACT FROM AUTHOR]

Residual thymic tissue is a common incidental finding in thoracic CT of human adults. To determine whether presumed residual thymic tissue is also a common incidental finding in adult dogs, a two part‐study was performed. The first part was a prospective, descriptive design where CT examination was performed in six canine cadavers within 24 h after death and presumed residual thymic tissue was examined pathologically. The second part of the study was a retrospective, analytical design where medical records of our institution were searched for thoracic CT scans of adult dogs performed in the year 2020. Age, sex, breed, presence of presumed thymic tissue, location, shape, attenuation, homogeneity, and width of the tissue were recorded and comparisons were performed using these data. In 4 of 6 of the prospective cases, thymic tissue was present on histology and in 2 of 6 dogs the presence of thymic tissue could not be confirmed. For the retrospective study, in 161/169 (95.3%) cases with presumed residual thymic tissue were detected. Shape and size were highly variable with either homogeneous (46.6%), heterogeneous (42.9%), or mixed (10.6%) attenuation. Dogs with presumed residual thymic tissue were significantly younger (median: 9.1 years; range: 1.2–14.3 vs. median: 10.5 years; range: 9.4–12.3) as were dogs with homogeneous attenuation of the tissue (median: 8.1 years; range: 1.2–14.3 vs. median: 9.5 years; range: 4.0–14.3). In conclusion, results indicated that presumed residual thymic tissue is a common CT finding in adult dogs and can be considered incidental. [ABSTRACT FROM AUTHOR]

Primary mediastinal choriocarcinoma, also known as non‐pregnant choriocarcinoma, is a rare malignancy unrelated to pregnancy, with a higher incidence in males. And primary mediastinal choriocarcinoma is mostly associated with organ and lymph node metastasis, with rapid progression and poor prognosis. Here, we report an extremely rare case of the primary anterior mediastinal choriocarcinoma that occurred in an 18‐year‐old man with multiple metastases of the lung and brain. [ABSTRACT FROM AUTHOR]

Background: Mediastinal teratoma is a medical rare disease that refers to the presence of a regrowing teratoma tumor in the mediastinum. At the pulmonary hospital dr. Ario Wirawan Salatiga, only one case was found, where the patient had previously been operated on at another hospital. Objective: The purpose of this paper was to contribute to the radiology literature by presenting a case of recurrent teratoma. Case Presentation: A 19-year-old male patient complained of persistent shortness of breath. The patient previously underwent teratoma surgery. The patient underwent chest X-rays, CT scans, abdominal and cardiac ultrasounds (USG), and as well as biopsies. The results of the CT scan found a teratoma-type mediastinal tumor accompanied by a large amount of pericardial effusion. A hyperechoic lesion with well-defined borders, round-oval, lobulated, and very large in size. Location in the mediastinum that is urgent and involves the left ventricle, right ventricle, left atrium, and right atrium. There is also an aortic compression lesion accompanied by calcification (+). Examination by ultrasonography (USG) of the heart found many pericardial but not found pressing. Heart valve function in patients did not show any abnormalities. Conclusion: Recurrent teratomas with large-volume pericardial effusions are rare. In this case study, a teratoma is located in the mediastinum. In this case, axial, coronal, and sagittal slices of a contrast thoracic CT scan can be used to establish the diagnosis. The results of heart USG found a pericardial effusion, the heart chambers do not collapse in this case of recurrent teratomas, indicating a mature teratoma type.

An otherwise well 28‐month‐old girl presented with fever/left thigh pain. Computed tomography identified a 7 cm right posterior mediastinal tumor extending to the paravertebral and intercostal spaces with multiple bone and bone marrow metastases on bone scintigraphy. Thoracoscopic biopsy diagnosed MYCN non‐amplified neuroblastoma. Chemotherapy shrank the tumor to 5 cm by 35 months of age. Robotic‐assisted resection was chosen because the patient was large enough and public health insurance coverage was available. At surgery, the tumor was well‐demarcated by chemotherapy and dissection posteriorly from the ribs/intercostal spaces and medially from the paravertebral space and azygos vein was facilitated by superior visualization/instrument articulation. The capsule of the resected specimen was intact on histopathology, confirming complete tumor resection. Despite minimum distance specifications between arms, trocars, and target sites with robotic assistance, excision was safe without instrument collisions. Robotic assistance should be actively considered for pediatric malignant mediastinal tumor provided the thorax is of adequate size. [ABSTRACT FROM AUTHOR]

Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a well- differentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

Germ cell tumors (GCTs) are a heterogeneous group of neoplasms that arise from the primordial germ cells of the human embryo, which are normally destined to produce reproductive cells sperm, or ova. GCTs can be present in both gonadal GCTs and extragonadal GCT sites. Pediatric GCTs are relatively rare tumors with an incidence of 2%-3%. Primary mediastinal germ cell tumors GCTs are very rare extragonadal GCTs that arise in the anterior mediastinum. In this report, we present the case of a 16-year-old boy with primary seminoma arising in the anterior mediastinum. The patient presented with the symptoms of cough, fever, and chest tightness. CT finding was in favor of a large expansive process measuring 12.4x6.7x14.2 cm in the anterior mediastinum, accompanied by a conglomeration of hilar lymph nodes in the level of brachiocephalic veins juncture. Fine needle biopsy and core biopsy were performed transthoracically, under the control of MSCT. Based on histology and immunohistochemistry, the diagnosis of mediastinal germ cell tumor with immunophenotype of seminoma was made. The patient was treated with 4 cycles of chemotherapy by BEP protocol without significant side effects and toxicities. The patient remained disease-free for 16 months. The purpose of reporting this case is to confirm that chemotherapy with cisplatin-based regimens has markedly improved the outcome of adults and children with GCTs as well.

Background: Several definitions were used to describe retrosternal goiter (RSG). The most accepted one describes when =50% of the mass portion of the goiter is in the mediastinum. It is considered a surgical challenge because of the difficulties faced during resection and the potential need for an extracervical approach. Objective: It is to present some of the operated cases referred to our Thoracic Surgery Department after multidisciplinary discussion and decision to operate such cases in combined team with ENT/General Surgery with analysis of their data. Materials and Methods: A retrospective analysis of 42 patients who underwent resections in a combined team for RSG between 2018 and 2022 in the theater of Cardiothoracic Surgery, Cairo University Hospitals. The patients were evaluated regarding their demographics, symptoms, level and side of extension in the mediastinum, approach, pathology, and postoperative complications. Results: The mean age was 57.1 years with male: female ratio 1:4.25. The most common symptom was dyspnea in 54% of cases. History of previous thyroid surgery was found in 17(40%) patients. There were 15(36%) patients who had extensions below the aortic arch. Sternal splitting was performed in 18 cases (43%) while thoracotomy was performed in 3cases (7%). Morbidity occurred in 5cases (11.9%) in the form of RLN palsy, phrenic nerve palsy, need for tracheostomy or Montgomery's tube with no postoperative mortality. The extension of RSG beyond the aortic arch and history of previous thyroidectomy were significant calling for extracervical approach. Conclusion: Retrosternal goiter is an indication for surgery to avoid airway compression, malignancy and difficult excision if the operation is delayed. [ABSTRACT FROM AUTHOR]

Abstract Background The fetu in fetu (FIF) is an extremely rare congenital condition characterized by a 2nd fetus that grows into the body of the healthy twin. Its thoracic location is more exceptional. Case presentation We report a case of intrathoracic mass in a 5-month-old female infant, diagnosed after an assessment for respiratory distress. She underwent an emergency left thoracotomy which allowed for the removal of a large thoraco-mediastinal mass inside a membranous sac containing a clear liquid mixed with vernix caseosa. The mass was completely covered with normal skin, three lobes similar to rudimentary outline of the head and limb. It was attached to a single large vascular pedicle. The pathological examination concluded that there was a high possibility of FIF. The postoperative follow-up was uncomplicated, and the child is still in good clinical condition after the 5-month follow-up. Conclusion The assessment of the respiratory distress in an infant with a mass centered by an axial skeleton on the chest x-ray and thoracic CT scan may suggest a diagnosis of intrathoracic FIF.

• A systemic review of mediastinal lymphoma studies with dosimetric comparisons involving proton therapy was conducted, with 139 patients. • Proton therapy (FB or DIBH) may improve heart dose, with possibly lower lung, breast, and integral dose as compared to IMRT-DIBH. • Optimal choice of radiation technique depends on mediastinal distribution of disease and clinic access to advanced technologies. To systematically review all dosimetric studies investigating the impact of deep inspiration breath hold (DIBH) compared with free breathing (FB) in mediastinal lymphoma patients treated with proton therapy as compared to IMRT (intensity-modulated radiation therapy)-DIBH. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the PubMed database to identify studies of mediastinal lymphoma patients with dosimetric comparisons of proton-FB and/or proton-DIBH with IMRT-DIBH. Parameters included mean heart (MHD), lung (MLD), and breast (MBD) doses, among other parameters. Case reports were excluded. Absolute differences in mean doses > 1 Gy between comparators were considered to be clinically meaningful. As of April 2021, eight studies fit these criteria (n = 8), with the following comparisons: proton-FB vs IMRT-DIBH (n = 5), proton-DIBH vs proton-FB (n = 5), and proton-DIBH vs IMRT-DIBH (n = 8). When comparing proton-FB with IMRT-DIBH in 5 studies, MHD was reduced with proton-FB in 2 studies, was similar (<1 Gy difference) in 2 studies, and increased in 1 study. On the other hand, MLD and MBD were reduced with proton-FB in 3 and 4 studies, respectively. When comparing proton-DIBH with proton-FB, MHD and MLD were reduced with proton DIBH in 4 and 3 studies, respectively, while MBD remained similar. Compared with IMRT-DIBH in 8 studies, proton-DIBH reduced the MHD in 7 studies and was similar in 1 study. Furthermore, MLD and MBD were reduced with proton-DIBH in 8 and 6 studies respectively. Integral dose was similar between proton-FB and proton-DIBH, and both were substantially lower than IMRT-DIBH. Accounting for heart, lung, breast, and integral dose, proton therapy (FB or DIBH) was superior to IMRT-DIBH. Proton-DIBH can lower dose to the lungs and heart even further compared with proton-FB, depending on disease location in the mediastinum, and organ-sparing and target coverage priorities. [ABSTRACT FROM AUTHOR]

Keywords: cancer; mediastinal; mediastinum; surgery; thyroid EN cancer mediastinal mediastinum surgery thyroid 701 706 6 10/13/22 20221101 NES 221101 Key points We retrospectively evaluated a single centre series of patients ( I n i : 15) after modified transmanubrial approach in case of malignant thyroid mass. In one patient a bilateral modified transmanubrial approach was necessary in one patient to permit a cava vein resection. Major intraoperative/postoperative complications were detected in two patients: one patient required an intraoperative blood transfusion due to a venous bleeding occurring during the cava vein dissection (2 units) and one patient had an irreversible recurrent nerve injury. [Extracted from the article]

INTRODUCTION: Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a universal pandemic in March 2020 by the World Health Organization and is a severe health issue with unprecedented morbidity and mortality rates. Both surgical and mediastinal emphysema have been seen in cases of critically ill COVID-19 patients in several hospitals in the Eastern Province of Saudi Arabia. METHODS: This was a retrospective, cross-sectional, multicentric study involving several hospitals in the Saudi Arabian Eastern Province. Data were collected from intensive care units (ICUs) in these hospitals from March 2 to August 2, 2020. The inclusion criteria consisted of all patients who tested positive for SARS-CoV-2 and were admitted to a critical care unit. RESULTS: Thirty patients required thoracic consultation and management, including 26 males (81.3%) and 4 females (12.5%) (1:0.15) who developed surgical and mediastinal emphysema requiring thoracic surgery intervention. Most of the patients were on high ventilation settings, and the mean duration of ventilator support was 16.50 ± 13.98 days. Two patients (6.3%) required reintubation. The median positive end-expiratory pressure (PEEP) was 12 ± 2.80 cmH2O with a median FiO2 of 70% ± 19.73. On average, thoracic complications occurred on day 3 (±6.29 days) postintubation. Ten patients (33.33%) experienced a pneumothorax associated with surgical emphysema (SE), 1 patient (3.33%) presented with only mediastinal emphysema; 17 patients (56.66%) with only SE, and 1 (3.33%) had mediastinal emphysema associated with SE. We noted a correlation between the duration of ventilator support, the length of ICU stay (P < 0.001), and the total length of stay (LOS) in the hospital (P < 0.001). Total length of hospital stay showed significant association with the onset of complications (P = 0.045) and outcomes (P = 0.006). A significant association between PEEP and the duration of ventilator support was also evident with a P value = 0.009 and the onset of complications (P = 0.043). In addition, we found a significant association between the group with pneumothorax in combination with SE, and their outcomes, with a P = 0.002. CONCLUSION: Surgical and mediastinal emphysema in the critically ill patients are usually attributed to barotrauma and high ventilations settings. During COVID-19 pandemic, these entities were seen and the pathogenesis was revisited and some attributed its presence to the disease process and destruction on lung parenchyma. The associated with extended LOS and delayed recovery in addition to poor prognosis were seen. Their presence is an indicator to higher morbidity and mortality.

Mediastinal masses span a wide histopathological spectrum. Inflammatory pseudotumors are rare and most commonly described in the lungs but these are reported in almost all the organs in the body. Mediastinal involvement is rare and difficult to diagnose. Clinical manifestations and laboratory investigations and radiology are non-specific. Histomorphology and Immunohistochemistry provide a valuable aid. Complete resection usually provides definitive diagnosis and is treatment of choice.

Abstract Background Lipoblastoma is a rare benign mesenchymal tumor of embryonal fat affecting mainly children below 3 years of age. It presents usually as a painless rapidly growing soft lobular mass in the extremities, trunk, and less frequently in the head-neck region. Preoperative imaging is used to assess the extent of disease and aid surgical planning. Complete surgical excision without injury to surrounding vital structures is the treatment of choice. Case presentation We report three interesting lipoblastoma cases: mediastinal lipoblastoma with airway compression and ipsilateral diaphragmatic eventration, neck lipoblastoma with intrathoracic extension, and huge thoracic inlet lipoblastoma with compression of common carotid and Lt subclavian arteries, brachial plexus, and ipsilateral diaphragmatic eventration. Complete excision of lipoblastoma mass was done via neck incision in two cases, and the third case required thoracoscopic excision of intrathoracic remnant 6 months later. All three patients had an excellent outcome. Conclusions Management of cervicothoracic lipoblastoma is a surgical challenge due to the potential for rapid growth and extension to different fascial planes; however, successful excision can be achieved via a neck approach. Complete surgical excision is essential to prevent local recurrence and improve the outcome.

We report a case of a 28‐year‐old immunocompetent woman found to have a mediastinal lesion on chest x‐ray performed as part of a visa renewal process. Computed tomographic imaging revealed a cystic superior anterior mediastinal mass. Although initially asymptomatic, the woman subsequently developed progressive chest discomfort. She underwent surgical resection of the mass. Histological assessment demonstrated necrotizing granulomatous inflammation, while Gene Xpert™ testing was positive for Mycobacterium tuberculosis complex and she was subsequently commenced on anti‐tuberculous therapy. [ABSTRACT FROM AUTHOR]

Mediastinal monophasic synovial sarcoma is a rare subtype that often lacks specific imaging characteristics, posing diagnostic challenges. This case report describes a mediastinal monophasic synovial sarcoma with vertebral metastasis, emphasizing imaging findings, differential diagnosis, and pathological features, thereby providing crucial support for accurate diagnosis and treatment planning., Competing Interests: All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

The superior aortic recess is one of the superior portions of the transverse sinus which is located around the ascending aorta. The fluid collection of the superior aortic recess is sometimes revealed on chest computed tomography, and it becomes more difficult to differentiate from a cystic tumor or lymphadenopathy when the amount of collected fluid is large or the fluid is extended into another area. We report two cases of fluid collection in the superior aortic recess which was misdiagnosed as a cystic mediastinal tumor that underwent surgical resection. An extremely large amount of fluid collection and cephalad extension led us to this clinical course., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Koike et al.)

Objective: To report the complications and outcomes associated with thoracoscopic cranial mediastinal mass resection in dogs., Animals: 49 client-owned dogs that underwent thoracoscopic cranial mediastinal mass removal., Methods: This was a retrospective cohort study (January 1, 2014, to July 31, 2023), and the medical records of 49 client-owned dogs that underwent thoracoscopic cranial mediastinal mass removal were reviewed. The signalment, history, clinicopathologic features, perioperative complications, and long-term outcome were recorded., Results: Preoperative myasthenia gravis (MG) and megaesophagus (ME) were identified in 17 of 49 (35%) dogs and 11 of 49 (22%) dogs, respectively. The median maximal tumor diameter on CT images was 4.7 cm (range, 2.7 to 8.5 cm). Nonemergent conversion to an open procedure was necessary in 4 of 49 (8%) dogs, and dogs with conversion to an open procedure had a significantly larger median maximal CT tumor diameter than dogs without conversion (P = .03). The most common tumor type was thymoma (37/49 [76%]). The overall median survival time for dogs with thymoma was 1,102 days (95% CI, 482 to upper bound not reached). The median survival time for dogs with thymoma and concurrent presurgical MG was 182 days (95% CI, 14 to upper bound not reached). Presurgical diagnosis of MG (P = .44) or ME (P = .69) was not associated with survival time., Clinical Relevance: Thoracoscopic removal of cranial mediastinal masses was associated with low conversion and complication rates. Long-term survival is possible, and thoracoscopic removal should be considered for select cases.

Background: Multiple methods have been implemented to limit the impact of radiotherapy on patients affected by mediastinal lymphoma, including breathing control techniques, image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT), although the actual diffusion of such techniques is unclear. No surveys have been published to date evaluating the techniques adopted at different centers. Methods: A survey with a dedicated questionnaire was submitted to 195 Italian radiotherapy centers, assessing items regarding the characteristics of the center and clinical practice in the treatment of mediastinal lymphomas. Results: A total of 43 centers (22%) responded, the majority of which were university hospitals (37.2%) or cancer care centers (27.9%). In 95.4% of the centers, IMRT was used in the clinical practice, and the most frequently employed techniques were VMAT (48.8% of centers) and non-rotational IMRT (31.7%). Comparison of multiple plans was performed by 66.7% of the responding centers. Dose constraints for organs at risk were consistently prescribed. IGRT techniques were adopted by 93% of the centers, while breathing control or gating techniques were routinely used by only 25.6% of the centers. A necessity to standardize OAR constraints and define guidelines was perceived by almost all participants. Conclusions: Modern radiotherapy techniques are widely used in the Italian centers, although with heterogeneous characteristics.

Abstract We report a case of a 28‐year‐old immunocompetent woman found to have a mediastinal lesion on chest x‐ray performed as part of a visa renewal process. Computed tomographic imaging revealed a cystic superior anterior mediastinal mass. Although initially asymptomatic, the woman subsequently developed progressive chest discomfort. She underwent surgical resection of the mass. Histological assessment demonstrated necrotizing granulomatous inflammation, while Gene Xpert™ testing was positive for Mycobacterium tuberculosis complex and she was subsequently commenced on anti‐tuberculous therapy.

Background: The fetu in fetu (FIF) is an extremely rare congenital condition characterized by a 2nd fetus that grows into the body of the healthy twin. Its thoracic location is more exceptional. Case presentation: We report a case of intrathoracic mass in a 5-month-old female infant, diagnosed after an assessment for respiratory distress. She underwent an emergency left thoracotomy which allowed for the removal of a large thoraco-mediastinal mass inside a membranous sac containing a clear liquid mixed with vernix caseosa. The mass was completely covered with normal skin, three lobes similar to rudimentary outline of the head and limb. It was attached to a single large vascular pedicle. The pathological examination concluded that there was a high possibility of FIF. The postoperative follow-up was uncomplicated, and the child is still in good clinical condition after the 5-month follow-up. Conclusion: The assessment of the respiratory distress in an infant with a mass centered by an axial skeleton on the chest x-ray and thoracic CT scan may suggest a diagnosis of intrathoracic FIF. [ABSTRACT FROM AUTHOR]

Hepatoid adenocarcinoma (HAC) is an extremely rare extrahepatic carcinoma, which is pathologically featured by hepatocellular carcinoma (HCC) and marked by producing alpha-fetoprotein (AFP). HAC of mediastinum is extremely rare. For inoperable patients, the curative treatment options have not been established, and the outcome of HAC is usually poor. Here, we present a case of mediastinal HAC with normal serum AFP level who achieved well-controlled and good response after local–regional interventional approach combined with systemic PD-1 inhibitor. A 53-year-old male who complained of chest pain was admitted to our hospital in February 2021. A chest CT scan revealed several tumors in his mediastinum. The laboratory data showed normal serum AFP level. HAC was diagnosed through pathological assessment of biopsy. Surgery was not available due to the infiltration of sternum. Local regional FOLFOX chemotherapy was given by transarterial infusion, followed by transcatheter arterial chemoembolization, and thereafter combined with systemic anti-PD-1 treatment. The patient achieved favorable disease control and apparent symptom relief. So transarterial interventional therapy combined immunotherapy may be a possible and promising treatment for mediastinal HAC. [ABSTRACT FROM AUTHOR]

الملخص: سرطان الغدد الليمفاوية بيركيت، هو سرطان يصيب الغدد الليمفاوية اللاهودجكينية من النوع ب (الخلايا اللِّمفاوية أو اللِّمفاويَّات البائيَّة). انسداد الوريد الأجوف العلوي يُعتبر من النادر حدوثه مع سرطان الغدد الليمفاوية بيركيت، وهو غالبا يحدث مع الأنواع الأخرى من سرطان الغدد الليمفاوية اللاهودجكيِنية مثل سرطان الخلايا الكبيرة. نبلغ في هذا التقرير عن حالة نادرة لسرطان الغدد الليمفاوية بيركيت من النوع المتفرق مع انسداد الوريد الأجوف العلوي لدى صبي يبلغ من العمر ١٦ عاما مصابا بكتل سرطانية في البلعوم، المنصف الصدري والغدة الكظرية. المريض أتى بانتفاخ في الجزء الأيسر العلوي من الرقبة لمدة شهرين، مع ازدياد الحجم مع مرور الوقت بدون أيَة أعراض أخرى، وفي اليوم الثاني من التنويم تم اختبار المريض لفايروس كورونا (كوفيد-١٩) وكانت النتيجة إيجابية. في الفحص السريري كان لديه انتفاخ في الغدة اللمفاوية الرقبية وانتفاخان في الجهتين من الغدد اللمفاوية الأذنية الخلفية. لم يكن هناك شيئا ملحوظا في الاختبار الصدري باستثناء بعض الدوالي الوريدية على صدر المريض. لم يكن هناك أية أعراض أو علامات لانسداد الوريد الأجوف العلوي بغض النظر عن نتائج الأشعة المقطعية. بدأ المريض على العلاج الكيميائي المكثف، وكانت لديه استجابة ملحوظة للعلاج في الكتل السرطانية في البلعوم والمنصف الصدري، مع استجابة طفيفة للكتلة السرطانية في الغدة الكظرية. لم يكن هناك أيَة مضاعفات ملحوظة. Abstract: Burkitt's lymphoma (BL) is an aggressive non-Hodgkin B-cell lymphoma. Superior vena cava obstruction (SVCO) is considered a rare presentation of BL and it is usually associated with other types of non-Hodgkin lymphoma such as diffuse large-cell. We report a rare case of sporadic BL with SVCO in a 16-year-old boy with nasopharyngeal, mediastinal, and adrenal masses. The patient presented with a two-month history of left upper neck swelling that increased with time and was not associated with other symptoms. The patient tested positive for COVID-19 on the second day after admission. On examination, he had enlarged solitary lateral cervical and bilateral posterior auricular lymph nodes. There were no signs or symptoms of SVCO regardless of the findings suggested by the computed tomography of the chest. The patient was treated with hyper-CVAD chemotherapy and showed a remarkable resolution of the nasopharyngeal and mediastinal masses with a mild response of his adrenal mass. There were no complications detected during this patient's management.

Mixed germ cell tumor (MGCT) mainly occurs in young women’s ovaries and men’s testicles and rarely occurs outside the gonad. Fewer than 10 cases of mediastinal MGCT are available in PubMed, Embase, and other databases in English, while mediastinal MGCT with three pathological components, such as yolk sac tumor, immature teratoma, and embryonal carcinoma, has not been reported previously. A 12-year-old male sought medical attention for chest discomfort and underwent a computed tomography (CT) scan. A large soft tissue mass occupying most of the left thoracic cavity and mediastinum was detected. A CT-guided biopsy was performed, and an MGCT was diagnosed with pathological components, including yolk sac tumor, immature teratoma, and a small amount of embryonal carcinoma. Due to the large size of the tumor, the patient was treated with an EP regimen (etoposide + cisplatin) and paclitaxel + ifosfamide + cisplatin interstitial chemotherapy. The patient was followed up for 6 months and was alive with the disease. To the best of our knowledge, this is the 10th patient with MGCT in the mediastinum. The incidence of mediastinal MGCT is low, but it should still be considered one of the differential diagnoses of isolated pleural fibroma and neurogenic tumors.

Hepatoid adenocarcinoma (HAC) is an extremely rare extrahepatic carcinoma, which is pathologically featured by hepatocellular carcinoma (HCC) and marked by producing alpha-fetoprotein (AFP). HAC of mediastinum is extremely rare. For inoperable patients, the curative treatment options have not been established, and the outcome of HAC is usually poor. Here, we present a case of mediastinal HAC with normal serum AFP level who achieved well-controlled and good response after local–regional interventional approach combined with systemic PD-1 inhibitor. A 53-year-old male who complained of chest pain was admitted to our hospital in February 2021. A chest CT scan revealed several tumors in his mediastinum. The laboratory data showed normal serum AFP level. HAC was diagnosed through pathological assessment of biopsy. Surgery was not available due to the infiltration of sternum. Local regional FOLFOX chemotherapy was given by transarterial infusion, followed by transcatheter arterial chemoembolization, and thereafter combined with systemic anti-PD-1 treatment. The patient achieved favorable disease control and apparent symptom relief. So transarterial interventional therapy combined immunotherapy may be a possible and promising treatment for mediastinal HAC.

Background: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) allows precise real-time sampling of intrathoracic lesions and is a minimally invasive, safe, and cost effective technique with high diagnostic yield. The aim of the current study is to evaluate utility of EBUS-TBNA cytology with cellblocks (CBs) in the diagnosis and subtyping of the intrathoracic lesions. Materials and Methods: It was a prospective study conducted from October 2015 to October 2017. We received 233 cases of intrathoracic lesions for EBUS-TBNA, of which CB was made in 217 cases. A flexible endobronchial ultrasound scope was used to sample the lesions. Results: There were 89 females and 128 males amongst the total 217 patients (age range: 14–85 years, mean age: 48.35 years). The smears from EBUS-TBNA contained adequate material in 137/144 [95.1%] non-neoplastic cases and 34/36 [94.4%] of the neoplastic cases, whereas the CBs provided adequate material in 94/144 [65.3%] non-neoplastic cases and 37/40 [92.5%] neoplastic cases. The CB helped subtyping the malignancy in 19 cases and of these immunohistochemistry (IHC) was done on the CB in 15 cases. The biopsy was non-diagnostic in 17/36 cases of granulomatous pathology and 4/18 neoplastic cases diagnosed with EBUS-TBNA.3. Conclusions: EBUS-TBNA provides rapid diagnosis through cytology and the material recovered in the same setting for the CB preparation can be used for immunohistochemical analysis and it may at times provide the diagnosis in cases where the smears are non-diagnostic.

Background: Assessment of response to antitubercular treatment (ATT) in mediastinal tuberculous lymph nodes (LNs) is challenging. Gold standard techniques such as biopsy and culture involve invasive procedures. Radiographic persistence of mediastinal LNs even after completion of ATT poses a treatment dilemma. In this study, we evaluated the changes in signal intensity (SI) and apparent diffusion coefficient (ADC) values of mediastinal LNs on magnetic resonance imaging (MRI), for response assessment to ATT. Materials and Methods: After institute ethics approval, a retrospective analysis of MRI images of 22 patients with 55 mediastinal tuberculous LNs was done. Clinically responsive patients of mediastinal tuberculous LNs who underwent chest MRI prior to ATT, or within 1 month of starting ATT, and second MRI performed at least after 2 months of start of the treatment were included. LN size, T1 and T2 signal characteristics (homogenously/heterogeneously and hyperintense or hypointense), T2 and T1 SI ratio, ADC values, and contrast enhancement characteristics were compared. Paired t-test and McNemar test were performed at a significance level of α =0.05. Results: Size of LN reduced, but 45 LNs measured >8 mm in second MRI. There was statistically significant decrease in the T2 and T1 SI ratios in second MRI, P = 0.026 and 0.008, respectively. No statistically significant difference was found in ADC values, P = 0.31. Conclusions: Decrease in T2 and T1 SI ratios of mediastinal tuberculous LNs can be used as a noninvasive imaging parameter to suggest response to ATT. However, ADC value is not a useful indicator of treatment response.

Objective: To determine the efficacy of diffusion-weighted MRI (DWI) and diffusion tensor imaging (DTI) in the characterization of mediastinal lymphadenopathy and the differentiation between malignant and benign lymph nodes (LNs).Methods: a retrospective evaluation of 58 patients with mediastinal lymphadenopathy that underwent DWI and DTI with calculation of apparent diffusion coefficient (ADC), fractional anisotropy (FA), and mean diffusivity (MD) values of LNs. Final diagnosis was made by the histopathology and proved metastatic (n = 21), lymphomatous (n = 14), granulomatous (n = 11) and reactive (n = 12) LNs.Results: Malignant mediastinal LNs had remarkably lower ADC and MD; (p = 0.001) and higher FA; (p = 0.001) than in benign LNs. The threshold of ADC, MD, and FA at (1.48, 1.32 × 10-3 mm2/s), (1.31, 1.33 × 10-3 mm2/s), (0.62, 0.52) to differentiate malignant from benign LNs has AUC of (0.89, 0.94), (0.96, 0.95), (0.72, 0.82), accuracy of (87%, 86%), (89%, 86%), (70%, 72%) by both observers respectively. The threshold of ADC, MD, and FA at (1.47, 1.32 × 10-3 mm2/s), (1.31, 1.3 × 10-3 mm2/s), (0.62, 0.67) used to differentiate metastatic from reactive LNs revealed AUC of (0.90, 0.94), (0.96, 0.96), (0.73, 0.77), accuracy of (87%, 81%), (87%, 81%), (72%, 66%) by both observers respectively. The mean ADC and MD values of metastatic LNs were statistically significant (p = 0.001) and (p = 0.002, 0.02) respectively when compared with that of lymphoma. The threshold of ADC, and MD (0.94, 0.97 × 10-3 mm2/s) and (0.87, 0.91 × 10-3 mm2/s) used to differentiates metastatic from lymphomatous nodes revealed AUC of (0.90, 0.91), (0.81, 0.74), an accuracy of (85%, 91%), (71%, 71%), by both observers respectively. The inter-class correlation between two observers for all nodes for ADC, MD and FA was r= 0.931, 0.956 and 0.885 respectively.Conclusion: Using ADC, MD, and FA can help in the characterization of mediastinal lymphadenopathy noninvasively. [ABSTRACT FROM AUTHOR]

Ectopic adrenocorticotrophic hormone (ACTH) syndrome is not common, which is more unusual when caused by paraganglioma. We herein present a 40-year-old Chinese male who was diagnosed with ACTH-dependent Cushing's syndrome. However, the localization of the ACTH source was troublesome due to the inconsistent results of the high-dose dexamethasone suppression test and the desmopressin stimulation test. Bilateral inferior petrosal sinus sampling was performed, and ectopic ACTH syndrome was diagnosed. After 68Ga-DOTATATE-PET/CT and 18F-FDG-PET/CT were performed, it was localized in the anterior mediastinum. Post-operation histopathology demonstrated an ACTH-secreting mediastinal paraganglioma. The patient obtained complete clinical remission after a mediastinal tumorectomy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a universal pandemic in March 2020 by the World Health Organization and is a severe health issue with unprecedented morbidity and mortality rates. Both surgical and mediastinal emphysema have been seen in cases of critically ill COVID-19 patients in several hospitals in the Eastern Province of Saudi Arabia. METHODS: This was a retrospective, cross-sectional, multicentric study involving several hospitals in the Saudi Arabian Eastern Province. Data were collected from intensive care units (ICUs) in these hospitals from March 2 to August 2, 2020. The inclusion criteria consisted of all patients who tested positive for SARS-CoV-2 and were admitted to a critical care unit. RESULTS: Thirty patients required thoracic consultation and management, including 26 males (81.3%) and 4 females (12.5%) (1:0.15) who developed surgical and mediastinal emphysema requiring thoracic surgery intervention. Most of the patients were on high ventilation settings, and the mean duration of ventilator support was 16.50 ± 13.98 days. Two patients (6.3%) required reintubation. The median positive end-expiratory pressure (PEEP) was 12 ± 2.80 cmH2O with a median FiO2 of 70% ± 19.73. On average, thoracic complications occurred on day 3 (±6.29 days) postintubation. Ten patients (33.33%) experienced a pneumothorax associated with surgical emphysema (SE), 1 patient (3.33%) presented with only mediastinal emphysema; 17 patients (56.66%) with only SE, and 1 (3.33%) had mediastinal emphysema associated with SE. We noted a correlation between the duration of ventilator support, the length of ICU stay (P < 0.001), and the total length of stay (LOS) in the hospital (P < 0.001). Total length of hospital stay showed significant association with the onset of complications (P = 0.045) and outcomes (P = 0.006). A significant association between PEEP and the duration of ventilator support was also evident with a P value = 0.009 and the onset of complications (P = 0.043). In addition, we found a significant association between the group with pneumothorax in combination with SE, and their outcomes, with a P = 0.002. CONCLUSION: Surgical and mediastinal emphysema in the critically ill patients are usually attributed to barotrauma and high ventilations settings. During COVID-19 pandemic, these entities were seen and the pathogenesis was revisited and some attributed its presence to the disease process and destruction on lung parenchyma. The associated with extended LOS and delayed recovery in addition to poor prognosis were seen. Their presence is an indicator to higher morbidity and mortality. [ABSTRACT FROM AUTHOR]