Case of the week 4.12.21
Publication Date: 2021-04-12
History
5 year old boxer. Peripheral lymphadenopathy.
3 images
Findings
Opposite lateral and VD radiographs of the thorax are available for interpretation.
There is a large, triangular to lobular, soft tissue opaque mass in the cranial mediastinum with its caudal aspect extending leftward to the cardiac silhouette on the VD projection. There is increased soft tissue opacity in the cranial mediastinum, immediately ventral to the thoracic trachea. There is the impression of a double opacity sign with mild splaying of the mainstem bronchi on the VD projection with suspect mild focal ventral deviation of the mainstem bronchi on the right lateral projection. There is a small volume of pleural effusion bilaterally with mild retraction and rounding of the ventral lung margins. There are multiple, pinpoint to small, soft tissue to mineral opaque foci in the pulmonary parenchyma, most consistent with end on vessels and/or benign pulmonary osteomas. The cardiovascular structures are normal. There are incidental musculoskeletal changes including periarticular new bone formation of the glenohumeral joints and spondylosis deformans.
Diagnosis
- Cranial mediastinal mass is most concerning for a neoplastic etiology, such as lymphoma or thymoma, with primary consideration given to lymphoma due to the concurrent peripheral and intrathoracic (cranial mediastinal and suspect tracheobronchial) lymphadenopathy.
- Pleural effusion is nonspecific and may be of neoplastic, hemorrhagic or inflammatory etiology, or may represent a transudate.
Discussion
On FNAs of the peripheral lymph node was diagnosed with B-cell lymphoma and has been started on chemotherapy.
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