Presentation
Chest pain and elevated D-dimer. ? PE
Patient Data
No filling defects identified within the pulmonary arterial circulation.
Lobulated anterior mediastinal mass with regions of soft tissue density. There is no pericardial fluid seen around the base of the heart (which would be expected if there was an effusion). The abnormality is an anterior mediastinal mass and in a patient of this age, lymphoma requires exclusion. Alternatively a reactive hyperplastic thymus may cause this appearance. I note the partially imaged liver is enlarged and the spleen appears bulky.
Pleurally based triangular opacities within the right middle lobe as well a similar thickening within the right lower lobe have a benign appearance. Minor dependent lung change bilaterally. The lungs are otherwise unremarkable. No suspicious pulmonary nodules or masses. No consolidation. No pleural effusions.
Case Discussion
Prominent and reactive thymic tissue can simulate pathology. This patient had a MRI elsewhere a few months later which showed reduction in size of the thymus.
A history was obtained in retrospect of a prolonged infective illness preceding the time of this scan.
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