Journal List > J Korean Soc Radiol > v.69(4) > 1087310

Lee, Baek, Song, Park, Seon, and Kim: Differential Points of Mediastinal Cystic Lesion in Chest Computed Tomography

Abstract

Purpose

To find differential diagnostic imaging findings of mediastinal cystic lesions in chest computed tomography.

Materials and Methods

We retrospectively reviewed imaging findings of 70 patients with histopathologically proven mediastinal cystic lesions. They were 33 male and 37 female patients.

Results

Among 70 cases, 49 cases were in the anterior mediastinum, 12 cases were in the middle mediastinum, and 9 cases were in the posterior mediastinum. 19 patients had symptoms. Chest discomfort was the most common symptom. When the cystic lesion was located in the anterior mediastinum, and unilocular, the possibility of thymic cyst was the most likely (p < 0.0027). When the cystic lesion was located in the anterior mediastinum and was multilocular with a relatively thick wall, the possibility of a mature cystic teratoma was the most likely (p < 0.001). When the lesion was a high attenuation cystic lesion located around the air-way, the possibility of a bronchogenic cyst was the most likely (p < 0.001).

Conclusion

Chest CT gives information about the location, loculation, wall thickness and internal attenuation of mediastinal cystic lesions. And certain details seen on CT imaging can help with the correct diagnosis, especially in the cases of thymic cyst, mature cystic teratoma and bronchogenic cyst.

Figures and Tables

Fig. 1
Mature cystic teratoma in a 23-year-old man who had chest discomfort. Contrast enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (arrow), calcification (long arrow), and fluid attenuation.
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Fig. 2
Mature cystic teratoma in a 43-year-old female with a history of chronic cough. Contrast enhanced CT shows multiloculated cystic mass in anterior mediastinum without fat nor calcification. It has thick and smooth enhancing wall (arrow).
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Fig. 3
Bronchogenic cyst in a 25-year-old man with a history of neck pain. Contrast material-enhanced CT scan shows a cyst with uniform high attenuation (42 Hounsfield unit) with an imperceptible wall. It is abutting trachea on right side (arrow).
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Fig. 4
Thymic cyst in a 76-year-old asymptomatic man. Contrast enhanced CT scan shows a thin-walled water attenuation cyst in anterior mediastinum.
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Table 1
CT and Clinical Findings in Each Diseases
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Table 2
Associations between Diagnosis and Uniloculation of Anterior Mediastinal Cystic Lesions
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Note.-OR = odds ratio, CI = confidence interval

Table 3
Wall Thickness of Pure Multilocular Cystic Lesions in Anterior Mediastinum
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