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April 2, 1982

Mediastinal Mass in a Patient With Liver Disease

JAMA. 1982;247(13):1873-1874. doi:10.1001/jama.1982.03320380065037

History  A 20-year-old woman was examined for a mediastinal mass detected on chest roentgenograms. Biopsy diagnosis of chronic active hepatitis had been made at age 12 years, three years after an episode of acute infectious hepatitis. Three episodes of significant hemorrhage from esophageal varices were documented. Bleeding hemorrhoids, peptic ulcer disease, and easy bruising were also reported. She had been receiving immune suppression therapy with prednisone and azathioprine (Imuran) for two years. On admission, splenomegaly and thrombocytopenia were noted. Erect posteroanterior (PA) and lateral chest x-ray films (Fig 1) and a contrast-enhanced computed tomographic scan of the lower thorax (Fig 2) were obtained.

Diagnosis  Esophageal varices and venous collateral secondary to portal hypertension.Lateral and PA chest x-ray films showed a retrocardiac mediastinal mass (Fig 1). The azygous vein appeared normal on erect films but was enlarged on supine tomography. On lateral tomograms, the superior margin of the mass corresponded