Did he have TB many years ago? Does this represent a pre-INH surgical intervention for TB? It looks like soemthing foreign placed into the thoracic cavity. I seem to recall that this would be an alternative to artificial pneumothorax for the treatment of TB.
Oh i thought that was in the lung; I hadn't cosidered it to be mediastinal. If it was lung I would have offered up non-smoking related tumors such as carcinoid, harmatoma, adenomas, but if it is indeed posterior mediastinal, the the ones baleeiro discussed...
Any history of thalassemia? It's unusual, but with enough strain on the marrow you can develop a posterior rounded mass due to extramedullary hematopoiesis.
All good comments. As it turns out, this is a schwannoma (first thing mentioned by Baleeiro). This is not my patient, but thought the film was great. It has been followed for at least 6 years and has been slowly growing. The patient has no neurologic symptoms and, at 87 years old, has been refusing surgery for several years.
Smart patient. At 87 there would be little to gain from surgery unless he was truly symptomatic. Most schwannomas are benign and this one is behaving so far. Any FHx of neourofibromatosis?
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Did he have TB many years ago? Does this represent a pre-INH surgical intervention for TB? It looks like soemthing foreign placed into the thoracic cavity. I seem to recall that this would be an alternative to artificial pneumothorax for the treatment of TB.
There is no history of any thoracic infection or surgery.
Wow! Very smooth and large posterior mediastinal mass. Neuro-endocrine tumors (Schwannomas and neuroblastomas) are a big possibility. Is he a smoker?
Non-smoker.
You mean non-smoker as stated very clearly on the history and I still didn't see it?
He seems too old for a germ-cell tumor and this would be an unusual presentation for lymphoma. Any odd occupational exposures or travel Hx?
No travel. No occupational exposures.
Oh i thought that was in the lung; I hadn't cosidered it to be mediastinal. If it was lung I would have offered up non-smoking related tumors such as carcinoid, harmatoma, adenomas, but if it is indeed posterior mediastinal, the the ones baleeiro discussed...
Any history of thalassemia? It's unusual, but with enough strain on the marrow you can develop a posterior rounded mass due to extramedullary hematopoiesis.
All good comments. As it turns out, this is a schwannoma (first thing mentioned by Baleeiro). This is not my patient, but thought the film was great. It has been followed for at least 6 years and has been slowly growing. The patient has no neurologic symptoms and, at 87 years old, has been refusing surgery for several years.
Smart patient. At 87 there would be little to gain from surgery unless he was truly symptomatic. Most schwannomas are benign and this one is behaving so far. Any FHx of neourofibromatosis?
No family history. He has done well for several years--I wouldn't want the surgery either.
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