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Special Feature
October 2002

An Abnormal Chest x-Ray

Arch Surg. 2002;137(10):1193-1194. doi:
Answer: An Anterior Mediastinal Mass

Figure 1. Chest x-ray.

Figure 2. Computed tomographic scan of the chest. Computed tomography revealed an anterior mediastinal mass separated from the lung. The patient underwent a neck exploration and the mass was found to be a thymoma. Mediastinal tumors or cysts are grouped according to their location in the anterior, middle, or posterior mediastinum.1The anterior mediastinum is defined as the area posterior to the sternum and anterior to the heart and great vessels. The middle mediastinum contains the heart and the pericardium, while the posterior mediastinum is posterior to the heart and anterior to the upper thoracic vertebrae. The most common lesions of the anterior mediastinum are thymomas (47%), lymphomas (22%), endocrine tumors (16%), and germ cell tumors (16%).2Most patients with thymomas are asymptomatic on initial examination, although those with symptoms of chest pain, cough, or dyspnea are more likely to have a malignant type of thymoma.3There is no characteristic radiographic appearance of a thymoma on chest x-ray but the CT scan can provide evidence of invasion into adjacent structures. The diagnosis is made when the mass is excised, usually through a median sternotomy.4Thymomas are also associated with a wide variety of autoimmune abnormalities, such as myasthenia gravis, hypogammaglobulimenia, and pure red blood cell aplasia.5The staging for a thymoma is according to clinical, anatomic, and histologic characteristics.6

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Article Information

Corresponding author and reprints: Syed Hashmi, MD, Division of Surgical Critical Care, Department of Surgery, Brigham and Women' s Hospital, 75 Francis St, Boston, MA 02115 (e-mail: shashmi@partners.org).

References
1.
Fraser  RSPare  JPFraser  RG  et al.  The normal chest. Fraser  RSPare  JPFraser  RGeds.Synopsis of Diseases of the Chest 2nd ed. Philadelphia, Pa WB Saunders1994;1- 116
2.
Mullen  BRichardson  JD Primary anterior mediastinal tumors in children and adults. Ann Thoracic Surg. 1986;42338- 345Article
3.
Kohman  LJ Approach to the diagnosis and staging of mediastinal masses. Chest. 1993;103(suppl)328S- 329SArticle
4.
McCart  JAGaspar  LInculet  RCasson  AG Predictors of survival following surgical resectionof thymoma. J Surg Oncol. 1993;54233- 238Article
5.
Rosai  JLevine  GD Tumors of the thymus. Firminger  HIed.Atlas of Tumor Pathology. Fasc 13. Ser 2. Washington, DC Armed Forces of Institute of Pathology1976;34- 212
6.
Lewis  JEWick  MRScheithauer  BW  et al.  Thymoma: a clinicopathologic review. Cancer. 1987;602727- 2743Article
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