纵隔静脉瘤

BackgroundThe cavernous hemangioma of mediastinum (CHM) is a rare benign lesion caused by congenital vascular dysplasia. However, its incidence is extremely low, and patients often lack relevant clinical symptoms. So we analyzed retrospectively some cases to investigate the imaging features of cavernous hemangioma of mediastinum (CHM) and improve the diagnostic accuracy.MethodsThe CT/MRI imaging features and clinical information of 19 patients with CHM were analyzed retrospectively.ResultsThe lesions of 18 CHM patients were single. Twelve cases in the anterior mediastinum and 8 in the posterior mediastinum. The diameter of CHM ranges from 2.0 to 7.0 cm. Thirteen cases were oval-shaped or round, 4 cases were lobulated, and 2 cases were irregular. Phleboliths or nodular calcification were identified in four cases. High signal of T2WI lipid suppression in two cases and blood vessel shadows were observed in two cases. After contrast-enhanced scan, the nodular enhancement of arteries were identified in 14 cases and contrast agent was further filled of the venous phase, where “fast in and slow out” feature was performed. One case showed inhomogeneous enhancement, one case performed “fast in and slow out” feature of multiphase-enhanced MRI. Besides, aberrant veins can be seen in or around the lesion among five cases.ConclusionsCHM is more frequently located at the anterior mediastinum than at the posterior mediastinum. The performance of phleboliths, high signal on T2WI fat suppression and DWI, the nodular enhancement of the artery, venous and delayed phase filling, enhanced “fast in and slow out,” and aberrant veins in the lesion are helpful for the diagnosis and differential diagnosis. Multiple period contrast-enhanced CT and MRI scan is helpful for the diagnosis of CHM.

PURPOSE To analyze the imaging manifestations of mediastinal hemangioma (MH) by CT and MRI to aid in its successful diagnosis and preoperative evaluation. METHODS Seventeen cases of MH diagnosed by histopathology combined with CT and MRI were retrospectively collected; and their CT and MRI features, including the lesions' site and range, shape, size, margin, density or signal, enhancement pattern, mass-cardiovascular interface, mass-pulmonary interface, and other characteristics were evaluated. RESULTS The anterior, middle, and posterior mediastinum were involved in 13, 13, and 8 cases, respectively. The masses size varied from 20 to 233 mm. Irregular, dumbbell-like, and oval masses were found in 13, 2, and 2 cases, respectively, while with pampiniform growth in 16 cases and expansive growth in 1 case. Mixed density, homogeneous density solid masses, and heterogeneous density masses with dominant fat were found in 9, 5, and 3 cases, respectively, showing mild or significant enhancement in aortic phase while no or mild enhancement in pulmonary artery phase. Draining veins were found in 16 cases and feeding arteries in 10 cases. Phleboliths were detected in 10 cases, splenic hemangiomas in 6 cases, and left lateral-chest-wall hemangioma in 1 case. In MRI sequences, mixed signal was found on T1WI and heterogeneous hypersignal with nodular or linear hyposignal on T2WI in 5 cases, mild or significant enhancement in 4 cases, draining veins in 2 cases, and no feeding arteries or phleboliths were seen. CONCLUSION Presence of phleboliths, pampiniform growth pattern, and aberrant draining veins are relatively specific characteristics in diagnosing MH.

… of a capsule, associated features) were ascertamed by review of surgical notes and surgical pathology … of intralesional fat on CT scans … The presence of fat in a mediastinal …

… the mediastinal hemangioma diagnosed by dynamic CT scans. Cheung et al. reported that a mediastinal hemangioma … Therefore, we assumed that the radiological and pathological …

Anastomosing haemangiomas are benign tumours with anastomosing vascular channels that may mimic angiosarcoma. While anastomosing haemangiomas have been described in diverse locations, particularly the abdominal/paraspinal region, data on anastomosing haemangiomas in the mediastinum remain limited. We report the clinicopathological, radiological and molecular characteristics of the largest single‐institutional series of mediastinal anastomosing haemangiomas.

… In summary, the findings of phleboliths and multiple enhancing vessels and the characteristic MR imaging appearance made mediastinal hemangioma the most likely diagnosis. …

… We review the cases of 15 patients with mediastinal hemangioma with longterm follow-up. … with a diagnosis of mediastinal hemangioma. The pathological specimens from these patients …

… not by mediastinal compartment but by MR findings that distinguish one mediastinal mass … enhancement pattern, same pathology; in this case, 2 mediastinal hemangiomas. (A) Chest …

Most pediatric masses in the chest are located in the mediastinum. These masses are often initially detected incidentally on chest radiographs in asymptomatic children, although some patients may present with respiratory symptoms. At chest radiography, the mediastinum has been anatomically divided into anterior, middle, and posterior compartments. However, with the International Thymic Malignancy Interest Group classification scheme, which is based on cross-sectional imaging findings, the mediastinum is divided into prevascular, visceral, and paravertebral compartments. In the prevascular compartment, tumors of thymic origin, lymphomas, germ cell tumors, and vascular tumors are encountered. In the visceral compartment, lymphadenopathy and masses related to the foregut are seen. In the paravertebral compartment, neurogenic tumors are most common. Using the anatomic location in combination with knowledge of the imaging and pathologic features of pediatric mediastinal masses aids in accurate diagnosis of these masses to guide treatment and management decisions. An invited commentary by Lee and Winant is available online. ©RSNA, 2021.

… Benign vascular tumors of the anterior mediastihum are rare. Most of them have been described either as case reports or as radiological curiosities; most of the small series in the …

Here, we describe our experience in treating a patient with mediastinal hemangioma, a rare neoplasm. An abnormal shadow was noted in the thoracic region of a 54-year-old woman at a health checkup, and she was referred to our hospital. A neurogenic tumor was suspected based on the findings of the chest X-ray and computed tomography scan. Thoracoscopic tumorectomy was performed. The tumor surface was smooth with a reddish-dark reddish color, and capillary blood vessels showed marked growth around the tumor. The tumor was composed of medium or large blood vessels with a relatively thick vascular wall containing smooth muscle. On immunostaining, anti-CD34 antibody and Factor VIII were positive and D2-40 was negative. Based on these findings, the tumor was diagnosed as mediastinal venous hemangioma.

… features and radiologic spectrum of hypervascular mediastinal masses… We will present an imaging algorithm to determine further … Pathology showed venous malformation with prominent …

… Here we report a case of cavernous hemangioma of the anterior mediastinum, and we review all 6I cases of mediastinal hemangioma reported in Japan over the past 50 years. …

A 71-year-old male patient visited Yeungnam University Hospital with abnormal chest computed tomography (CT) findings. Chest CT revealed multiple lung nodules and a posterior mediastinal tumor, the diagnosis of which was confirmed surgically. Magnetic resonance imaging (MRI) of the abdomen showed multiple small nodules, which were diagnosed as cavernous hemangioma in the liver based on the pathology results of the mediastinal and lung masses in combination with MRI findings. Cavernous hemangiomas are benign tumors that can occur throughout the body, mainly in the skin and subcutaneous tissue. The liver is the most common internal organ containing hemangiomas, whereas they are very rarely found in the lungs or mediastinum.

Background Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases. Case presentation We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed. Conclusion Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports.

… We have documented a case of a posterior mediastinal cystic hemangioma in a 58-year-old man which presented as bilateral bloody pleural effusion. Although the cyst was …

… report a case of mediastinal venous hemangioma that was successfully treated by thoracoscopic surgery. … Cavernous hemangioma of the anterior mediastinum: case report and 50-year …

… hemorrhage during surgery. (7) This study presents a case of this kind of tumor operated via an anterior trans-cervico-thoracic approach. In the anterior cervico-mediastinal surgery (7) ,…

… They are rarely found in the mediastinum. We present a case of mediastinal LVM, with review of the … The tumor was resected completely using video-assisted thoracoscopic surgery. The …

… In our case, a VH was adjacent to the thymus and was suspected to be a solid tumor rather … neoplasm before surgery. We report of a case of VH in the anterior mediastinum and a review …

… ' The case described in this pap hemangioma of the leftlower an diastinum. CASE REPORT A 23-year-… , an asymptomatic mass in the left ant mediastinum which was discovered oI chest …

Background Mediastinal haemangioma is a rare type of tumour and accounts for ≤0.5% of all mediastinal tumours. Mediastinal haemangioma is often nonspecific upon examination by imaging. Mediastinal haemangioma diagnosis is difficult to confirm before surgery because the characteristic features of diagnostic imaging are poor, and these lesions are extremely rarely encountered in clinical practice. Case Description We herein report a case of thoracoscopic resection of a cavernous haemangioma in the anterior mediastinum. A 40-year-old man was referred to our hospital for a health examination. A chest computed tomography scan showed a mass with irregular contrast enhancement and a smooth surface. Using video-assisted thoracoscopic surgery, the tumour was completely extirpated and confirmed histologically to be a cavernous haemangioma. The patient recovered well, was discharged, he has since had no recurrences, and continues to be closely monitored as an outpatient. Conclusions Mediastinal haemangiomas, a rare type of mediastinal tumour, are typically benign and located in the anterior mediastinum, and lack specific symptoms and relevant imaging features. We found that minimally invasive thoracoscopic resection provided a satisfactory view and facilitated correct handling of a mediastinal cavernous haemangioma. Although such tumours are mostly benign and the prognosis is good, we recommend aggressive surgical management to avoid missing malignant lesions.

The terminology applied to vascular anomalies has been inconsistent and confusing. Thus, misdiagnosis and misunderstanding of the natural history and treatment options for afflicted patients is common. The International Society for the Study of Vascular Anomalies (ISSVA) has accepted the terminology proposed by Mulliken in 1982 that classifies lesions broadly into vascular tumors and vascular malformations.

… the nonhemangioma vascular tumors outlined in the ISSVA … lesions of the torso (including intrathoracic cavity, Case 1), and … hemothorax and mediastinal shift with < 2% residual tumor. …

… capillary arteriovenous malformation in the nasopharynx. A case described as bizarre vascular … tumour was crucial in avoiding the misdiagnosis as a mediastinal angiosarcoma, which …

… for the Study of Vascular Anomalies (ISSVA) has been at the … occurring in the neck, axilla, mediastinum/chest, or groin, with … in the section on sclerotherapy of venous malformations. …

… The differential diagnosis of this neoplasm includes benign haemangiomas of various kinds, … , as compared with 17 % and 3 % for benign varieties (21). Despite the scarcity of reports an …

… Due to the benign nature of the tumor, it was elected not to … terior mediastinum (including tumors of the sympathetic chain) … in the differential diagnosis of a posterior mediastinal mass. A …

10.4103/0970-2113.129883 4. McGrath EE, Blades Z, Anderson PB. Chylothorax: Aetiology, diagnosis and therapeutic options. Respir Med 2010;104:1-8. 5. Janjetovic S, Janning M, Daukeva L, Bokemeyer C, Fiedler W. Chylothorax in a patient with Hodgkin’s lymphoma: A case report and review of the literature. Tumori 2013;99:e96-9. 6. Doerr CH, Allen MS, Nichols FC 3rd, Ryu JH. Etiology of chylothorax in 203 patients. Mayo Clin Proc 2005;80:867-70. 7. Morris-Stiff G, Cheang P, Key S, Verghese A, Havard TJ. Does the surgeon still have a role to play in the diagnosis and management of lymphomas? World J Surg Oncol 2008;6:13.

… We report posterior mediastinal hemangiomas in a 4-month-old … surgical specimens established the final diagnosis. Although … Hemangiomas are benign, richly vascular tumors that …

… CT imaging features of mediastinal cavernous hemangioma are often described as an enhancing … are rare cases with non-enhancement after the enhanced CT was reported. Surgical …

Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.

Abstract Mediastinal masses represent a heterogeneous group of entities characterized by a variety of histopathological and radiological features. Imaging plays a pivotal role in the detection and interpretation of mediastinal abnormalities. CT remains the modality of choice due to its high spatial and temporal resolution and its ability to assess tissue composition, including the detection of fluid, fat, and calcifications. MRI represents a complementary tool in specific scenarios, such as differentiating complicated cysts from solid lesions or identifying intracellular fat content, as seen in thymic hyperplasia. The differential diagnosis of mediastinal masses relies primarily on the location of the mass and tissue composition, integrated with clinical characteristics of the patient. This review discusses the most common mediastinal masses in adults, providing a practical approach to their differentiation mainly based on the predominant density pattern and location.

© www.appliedradiology.com July 2017 While chest computed tomography (CT) is the mainstay for initial evaluation of mediastinal masses detected incidentally by radiography or by clinical presentation, CT results are frequently indeterminate. Thoracic magnetic resonance imaging (MRI) offers a noninvasive way to further characterize mediastinal lesions, their site of origin, and their involvement of adjacent structures. Its higher soft-tissue contrast than CT yields superior tissue characterization and often provides more diagnostic specificity. Thoracic MRI has been shown to significantly alter clinical management, reduce the need for patient follow-up, and lower the surgical intervention rate.1 Despite the advantages of thoracic MRI, however, the modality remains underutilized in the thorax2 because of insufficient training, education, and awareness of its value.3 As is true elsewhere in the body, MRI allows improved differentiation of cystic from solid lesions and better distinction between simple and complex cystic lesions in the thorax. Chemical shift gradient echo MR imaging (inand opposed-phase imaging) detects microscopic fat; fat-saturation techniques identify macroscopic fat. MRI can also identify the presence of blood products, smooth muscle, cartilage, and fibrous tissue within a lesion. Through the assessment of dynamic contrast enhancement (DCE) patterns and the extent of restricted diffusion, providing information about lesion vascularity, cellularity, and tissue architecture, MRI can further characterize various types of tissue. This article will discuss MR imaging technique and illustrate how the modality improves diagnostic specificity in mediastinal mass characterization by reviewing the features of selected mediastinal lesions and demonstrating how MR helps narrow the differential diagnosis, often to a single entity.

… The MR imaging appearance of a hemangioma reflects its … fat may undergo fat necrosis with associated calcification and … primordial fatty tissue, such as the head and neck, mediastinum…

PURPOSE Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses. METHOD We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented. RESULTS Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated. CONCLUSIONS Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.

BackgroundMultiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis.MethodsRadiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another.ResultsTissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases.ConclusionFamiliarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment.Teaching Points• CT and MRI are important for the diagnosis of mediastinal masses.• The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses.• Symptomatology and patient age affect the likelihood of malignancy.

… mediastinal masses encompass parathyroid adenomas (approximately 20% are ectopic and can be found within the anterior mediastinum), hemangiomas, … , the Masaoka-Koga staging …

Benign mediastinal cysts are challenging to diagnose. Although Endoscopic Ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) can accurately diagnose mediastinal foregut cysts, little is known about their complications. This paper reports a rare case in which EUS-FNA performed on mediastinal hemangioma resulted in an aortic hematoma. A 29-year-old female patient was commissioned for EUS of an asymptomatic accidental mediastinal lesion. Chest CT revealed a 4.9×2.9×10.1 cm thin-walled cystic mass in the posterior mediastinum. EUS revealed a large, anechoic cystic lesion with a regular thin wall with negative Doppler. EUS-guided FNA was performed using a single-use 19-gauge aspiration needle (EZ Shot 3; Olympus, Tokyo, Japan), and approximately 70 cc of serous pinkish fluid was aspirated. The patient was in a stable condition with no signs of acute complication. One day after EUS-FNA, thoracoscopic resection for mediastinal mass was conducted. The purple and multi-loculated large cyst was removed. Upon removal, however, an aortic hematoma caused by a focal descending aortic wall injury was observed. After a few days of close observation, the patient was discharged upon stable 3D aorta angio CT findings. This paper reports a rare and severe complication of EUS-FNA, in which an aspiration needle caused a direct injury to the aorta. The injection must be performed carefully to avoid damaging the adjacent organs or digestive tract walls.