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Everything you need to know about Computed Tomography (CT) & CT Scanning

Chest: Mediastinal Masses Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Chest ❯ Mediastinal Masses

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  • “Rosai-Dorfman disease represents a wide-spectrum disease not limited to lymph nodes. Radiologically, RDD has diverse imaging findings. However, most lesions were hypermetabolic on 18F-fluorodeoxyglucose positron-emission tomography/computed tomography and isointense on T1-weighted imaging. Patients with RDD have a high rate of comorbid diseases including autoimmune disease, viral infections, and cancer.”
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • “Rosai-Dorfman disease (RDD) or sinus histocytosis with mas- sive lymphadenopathy is a rare, classically nonmalignant, and proliferative disorder of histiocytes that was first described in 1969 by Rosai and Dorfman. The usual presentation is a young patient in his first or second decade of life with cervical and submandibular lymphadenopathy. Rarely, RDD may be associatedwith systemic symptoms such as fever, malaise, and weight loss. A high erythrocyte sedimentation rate, neutrophilic leukocytosis, anemia, and polyclonal gammopathy frequently present in RDD patients. No etiology has been established for RDD, but in ectious, neoplastic, autoimmune, and immunodeficiency-related causes have been hypothesized.”
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • “Radiographically, RDD has nonspecific image findings, and presentation varies according to the affected organ. Nodal disease presents as a pathological lymph node enlargement, with the cervical chain being the most commonly affected. Axillary, inguinal, hilar, mediastinal, and retroperitoneal lymph nodes are less frequently affected and usually smaller than the cervical chain.”
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • “Anatomically, the head and neck including cervical lymph nodes are the most commonly affected locations by RDD. The predilection of RDD to affect the head and neck is well documented.Among 423 RDD patients, head and neck RDD represented 38% of extranodal disease. However, Goyal et al reported subcutaneous tissue as the most common affected anatomical location by RDD.”
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • "Rosai-Dorfman disease represents a wide-spectrum disease not limited to the lymph nodes, with extranodal disease being possibly more common than nodal disease. Radiologically, RDD had diverse imaging findings. However, most lesions are hypermetabolic on PET/CT and isointense on T1-WI. In addition, we found a high rate of comorbid diseases in RDD patients, in- cluding autoimmune disease, viral infections, and cancer. Rosai- Dorfman disease may have a difference in organ involvement among ethnic groups.”
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • Main Points
    Rosai-Dorfman disease is more likely to affect extranodal tis- sues, especially the head and neck. More than half (62.5%) of our population had a pure extranodal disease. Absence of nodal disease does not exclude RDD from the differential. Most RDD lesions are hypermetabolic on PET/CT and isointense on T1-WI MRI.
    Thirty-two percent of our patients had comorbid diseases. The most common comorbid diseases in patients with RDD were autoimmune diseases, viral infections, and cancers.
    Rosai-Dorfman disease organ affection is slightly different be- tween ethnic groups. Central nervous system RDD is more common in white ethnicity.
    Disease Characteristics, Radiologic Patterns, Comorbid Diseases, and Ethnic Differences in 32 Patients With Rosai-Dorfman Disease
    Mohamed Elshikh et al.
    J Comput Assist Tomogr 2020;44: 450–461
  • "Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial cysts and diverticula share similar developmental origin and may appear as an incidental finding in chest roentgenogram in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of the surrounding anatomy. Cardiac MRI is recommended in the evaluation of the compressive effects caused by the pericardial cysts. The authors recommend echocardiography for serial follow up and image guided aspiration of the pericardial cyst in presence of compressive effects leading to cardiovascular and airway symptoms.”
    Current concepts of diagnosis and management of pericardial cysts.
    Kar SK1, Ganguly T2.
    Indian Heart J. 2017 May - Jun;69(3):364-370
  • "Cystic lesions within the pericardial space are a rare entity and comprise 7% of the mediastinal masses and 33% of mediastinal cysts. The incidence of a pericardial cyst is 1 in 100,000 populations and most of the pericardial cysts presenting as mediastinal opacity are detected incidentally.They are usually found in the third or the fourth decade of the life and male and female are affected equally.In 70% of the cases, these cysts are located in right cardiophrenic angle, in 22% cases in the left cardiophrenic angle and in 8% cases are located in the posterior or the anterior-superior part of the mediastinum.”
    Current concepts of diagnosis and management of pericardial cysts.
    Kar SK1, Ganguly T2.
    Indian Heart J. 2017 May - Jun;69(3):364-370
  • “Most of the cases (50–75%) are asymptomatic and are diagnosed incidentally during radiological investigations ordered as routine investigation for other causes of illness. Symptoms may appear due to compression of the nearby structures, such as heart, great vessels, oesophagus and the tracheobronchial tree.”
    Current concepts of diagnosis and management of pericardial cysts.
    Kar SK1, Ganguly T2.
    Indian Heart J. 2017 May - Jun;69(3):364-370
  • “Computerised tomography scan (CT scan) is considered as the best modality for the diagnosis as it provides an excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, pericardial thickening, pericardial masses, and congenital anomalies helping in surgical decision making. Inaccuracies in diagnosis arise when the cyst is in an unusual location, or the protein content of the cyst fluid is high.”
    Current concepts of diagnosis and management of pericardial cysts.
    Kar SK1, Ganguly T2.
    Indian Heart J. 2017 May - Jun;69(3):364-370
  • "The thymus changes with age. Its shape and the proportion of solid tissue and fat vary between individuals, yet there is no comprehensive work describing the size and morphology of the normal thymus on CT. As a result, many adults with some preserved soft tissue in the thymus may undergo extensive work-up to exclude mediastinal tumor. "
    Normal CT characteristics of the thymus in adults
    Author links open overlay panel
    Simanovsky N et al.
    European Journal of Radiology
    Volume 81, Issue 11, November 2012, Pages 3581-3586
  • "Thymic density and volume decreased progressively with age. No solid tissue component was seen in the thymus in patients older than 54 years. In the majority of patients, the thymus had an arrowhead shape, with middle position. However, great variability in thymic shape and border were noted. There was a highly significant relationship between density and patient age (p < 0.0001). "
    Normal CT characteristics of the thymus in adults
    Author links open overlay panel
    Simanovsky N et al.
    European Journal of Radiology
    Volume 81, Issue 11, November 2012, Pages 3581-3586
  • Our study demonstrated a spectrum of appearance of a normal thymus on CT and the sex difference in the middle and older age groups. In the present cohort from the FHS with the mean age of 58.9 years, only 8% (208/2540) of overall participants had thymic glands with half or more soft-tissue parenchyma (Scores 2 and 3), and 74% (1869/2540) showed a complete fatty replacement of the thymic gland due to advanced involution."
    Normal Thymus in Adults: Appearance on CT and Associations with Age, Sex, BMI and Smoking
    Tetsuro Araki et al.
    Eur Radiol. 2016 January ; 26(1): 15–24
  • "In the present study, meticulous measurements of the thymic glands revealed that those in male were significantly larger than those in female, thus justifying the data split according to sex, providing reference values for the size of a normal thymus. However, it should be noted that thymus glands at middle and older age, especially in male, are usually not applicable for measurements because of advanced fatty degeneration with an obscured contour. Moore et al suggested that the overall size of the thymus may not change with aging in adults."
    Normal Thymus in Adults: Appearance on CT and Associations with Age, Sex, BMI and Smoking
    Tetsuro Araki et al.
    Eur Radiol. 2016 January ; 26(1): 15–24
  • "We aimed to combine previously described pregnancy specific CTPA technique alterations with a dose reduction strategy and a low kVp technique to yield a low dose CTPA protocol specifically tailored to pregnant patients, without a reduction in clinical image quality. The results demonstrate that by using a low kVp CTPA technique tailored to pregnancy, effective doses under 1 mSv are routinely achievable in a pregnant population."
    Low dose computed tomography pulmonary angiography protocol for imaging pregnant patients: Can dose reduction be achieved without reducing image quality?
    Halpenny D et al.
    Clinical Imaging: Volume 44, July–August 2017, Pages 101-105
  • “A diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors of incorrect diagnosis of chest CT. VATS is a reliable approach for the surgical resection of thymic cysts. We think that local resection is adequate for simple thymic cysts. However, thymectomy is necessary when there is suspicion of a thymoma or multilocular thymic cyst, and radical thymectomy is advisable for patients with autoimmune diseases.”

    
Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts.
Wang X et al.
J Thorac Dis. 2017 Dec;9(12):5203-5211

  • “Thymic cysts are rare benign developmental anomalies and there is no consensus management for thymic cysts. The aim of this study was to disclose the efficacy of perioperative diagnosis for thymic cysts by chest computerized tomography (CT) and to elucidate the surgical procedure by video-assisted thoracic surgery (VATS) in the management of thymic cysts.”


    Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts.
Wang X et al.
J Thorac Dis. 2017 Dec;9(12):5203-5211

  • “It is difficult to distinguish thymic cysts from the solid neoplasm of the thymus in some patients, and there are few large-scale studies that analyzed the preoperative diagnoses of thymic cysts. Preoperative diagnosis of a thymic cyst mainly depends on an imaging examination. In our study, only 37.0% patients presented with a widened mediastinum or mediastinal mass in the chest X-ray, and none were diagnosed with a thymic cyst. The chest X-ray can only be considered a screening examination. The chest CT is the most widely used imaging examination for mediastinal disease. For thymic cysts, the chest CT can describe the shape, contour, CT value, relationship to adjacent tissue, and the contrast-enhanced CT appearance. The typical imaging performance of the thymic cyst was oval in shape, and had a smooth contour, cystic density, homogeneous attenuation, and thin or imperceptible walls.”


    Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts.
Wang X et al.
J Thorac Dis. 2017 Dec;9(12):5203-5211
  • “ A diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors of incorrect diagnosis of chest CT. VATS resection should be considered the primary therapeutic option for the management of thymic cysts. We think that local resection is adequate for simple thymic cysts. However, thymectomy is necessary when there is suspicion of a thymoma or multilocular thymic cyst. For patients with autoimmune diseases, a radical extended thymectomy is advisable.”

    
Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts.
Wang X et al.
J Thorac Dis. 2017 Dec;9(12):5203-5211
  • “Mediastinal masses span a wide histopathological and radiological spectrum. The most frequent lesions encountered in the mediastinum are thymoma, neurogenic tumours and benign cysts, altogether representing 60% of patients with mediastinal masses. Neurogenic tumours, germ cell neoplasms and foregut cysts represent 80% of childhood lesions, whereas primary thymic neoplasms, thyroid masses and lymphomas are the most common in adults.”

    A diagnostic approach to the mediastinal masses

    Juanpere S et al.
    Insights Imaging. 2013 Feb; 4(1): 29–52.
  • “The mediastinum is demarcated by the pleural cavities laterally, the thoracic inlet superiorly and the diaphragm inferiorly. It is further divided into anterior, middle and posterior compartments by many anatomists . Anterior mediastinal tumours account for 50% of all mediastinal masses, including thymoma, teratoma, thyroid disease and lymphoma. Masses of the middle mediastinum are typically congenital cysts while those arising in the posterior mediastinum are often neurogenic tumours.”

    A diagnostic approach to the mediastinal masses

    Juanpere S et al.
    Insights Imaging. 2013 Feb; 4(1): 29–52.
  • “Usual symptoms at presentation are cough, chest pain, fever/chills and dyspnea. Localizing symptoms are secondary to tumour invasion (respiratory compromise; paralysis of the limbs, diaphragm and vocal cords; Horner syndrome; superior vena cava syndrome), while systemic symptoms are typically due to the release of excess hormones, antibodies or cytokines.”

    A diagnostic approach to the mediastinal masses

    Juanpere S et al.
    Insights Imaging. 2013 Feb; 4(1): 29–52.
  • “Hodgkin disease (HD) has a bimodal distribution of incidence peaking in young adulthood and again after the age of 50 years. Most patients experience constitutional symptoms. Four subtypes of HD are described: nodular sclerosis (by far the most common histological subtype), lymphocyte-rich, mixed cellularity and lymphocyte depleted HD. CR is abnormal in up to 76% of patients with HD, often showing enlargement of the prevascular and paratracheal nodes. Characteristic features on imaging are a homogeneous soft-tissue anterior mediastinal mass with mild to moderate contrast enhancement, irregular contours, surface lobulation, absence of vascular involvement, and high prevalence of associated mediastinal lymphadenopathy. Cystic and necrotic changes can be identified.”

    A diagnostic approach to the mediastinal masses

    Juanpere S et al.
    Insights Imaging. 2013 Feb; 4(1): 29–52.
  • “The two most common forms of mediastinal non-Hodgkin disease (NHD) include diffuse large B-cell lymphoma and T-cell lymphoblastic lymphoma. T-cell lymphoblastic lymphoma mainly occurs in children and adolescents. The most common CT appearance is a large mediastinal mass representing thymic and lymph node enlargement, which compresses the airway and cardiovascular structures. Low attenuation areas reflecting necrosis are commonly seen. Primary mediastinal diffuse large B-cell lymphomas tend to occur in young to middle-aged adults with a mean age of 30. It accounts for 7% of all cases of NHD and about 10% of all cases of high-grade NHD .”

    A diagnostic approach to the mediastinal masses

    Juanpere S et al.
    Insights Imaging. 2013 Feb; 4(1): 29–52.
  • Thymoma: Facts
    - Thymomas are defined as tumors originating in the epithelial components of the thymus
    - 70% to 80% are totally encapsulated and classified as benign, and the remainder represents the group of malignant thymomas
    - Maximal diameters of the invasive thymomas ranged from 3 to 10 cm, and thymic carcinomas ranged from 5 to 25 cm.
  • “Preoperative CT findings can predict the likelihood of successful surgical resection and could help to identify patients who might benefit from neoadjuvant chemotherapy.”
    Preoperative computed tomography findings predict surgical resectability of thymoma.
    Hayes SA et al
    J Thorac Oncol. 2014 Jul;9(7):1023-30
  • “Thymic neoplasms are rare tumors that account for less than 1% of all adult malignancies, with reported incidences of one to five cases per 1 million people per year . The primary epithelial neoplasms of the thymus are thymoma and thymic carcinoma, with thymoma being more common. Thymic carcinoma is a more aggressive disease that is often diagnosed with needle biopsy before treatment planning; it has been discussed elsewhere.”
    Role of Imaging in the Diagnosis, Staging, and Treatment of Thymoma
    Benveniste MFK et al.
    RadioGraphics
     Volume 31, Issue 7 pp. 1847-1861
  • “Thymomas typically occur in patients older than 40 years of age, are rare in children, and affect men and women equally. Most thymomas are solid neoplasms that are encapsulated and localized to the thymus. Approximately one-third exhibit necrosis, hemorrhage, or cystic components, and approximately one-third invade the tumor capsule and the surrounding structures..”
    Role of Imaging in the Diagnosis, Staging, and Treatment of Thymoma
    Benveniste MFK et al.
    RadioGraphics
     Volume 31, Issue 7 pp. 1847-1861
  • “The preoperative CT characteristics that correlated with an incomplete surgical resection included a lobulated tumor contour (p = 0.016), greater than or equal 50% abutment of the circumference of an adjacent vessel (p < 0.001), thoracic lymphadenopathy (p = 0.029), adjacent lung changes (p = 0.005) and pleural nodularity (p = 0.001). Tumor size was larger in the incompletely versus completely resected groups, with mean values of 9.7 and 6.9 cm (p value 0.013). On multivariate analysis, only degree of abutment of adjacent vessels and pleural nodularity were independent predictors of incomplete resection.”
    Preoperative computed tomography findings predict surgical resectability of thymoma.
    Hayes SA et al
    J Thorac Oncol. 2014 Jul;9(7):1023-30
  • “On multivariate analysis, only degree of abutment of adjacent vessels and pleural nodularity were independent predictors of incomplete resection.”
    Preoperative computed tomography findings predict surgical resectability of thymoma.
    Hayes SA et al
    J Thorac Oncol. 2014 Jul;9(7):1023-30
  • “ Pulmonary lymphoma is rare and represent less than 1% of primary lung cancer. Lung involvement is usually secondary. Primary pulmonary lymphoma encompass 10% of extranodal lymphoma. The majority are non-Hodgkin lymphoma (non-HL) and primary pulmonary HL is very uncommon. The diagnosis is only justified if hilar lymph nodes are uninvolved and disease elsewhere has been excluded.”
    Primary pulmonary classic Hodgkin’s lymphoma
    Binesh F et al.
    BMJ Case Rep. 2011 Jun 29;2011
  • “The pulmonary lesions are single nodule in one third of the patients and multiple nodules in one half. Occasionally, bilateral reticulonodular infiltrates or pulmonary consolidation are seen. Upper lobes involvement are more common, and there may be cavitations in the larger ones.”
    Primary pulmonary classic Hodgkin’s lymphoma
    Binesh F et al.
    BMJ Case Rep. 2011 Jun 29;2011
  • “Thymoma is the most common primary neoplasm of the anterior mediastinum, but it accounts for <1% of all adult malignancies. It is the most common of the thymic epithelial neoplasms, which, in addition to thymoma, include thymic carcinoma and thymic carcinoid.”
    Advances in Thymoma imaging
    Marom EM
    J Thorac Imaging 2013 28(2):69-80
  • “Currently, imaging is predominantly carried out with computed tomography (CT). In selected cases, there is a role for magnetic resonance imaging and F-fluorodeoxyglucose positron emission tomography in the investigation of an anterior mediastinal mass suspected to be thymoma. Because patients with advanced thymoma receive neoadjuvant chemotherapy, radiologists should be familiar with the staging system of thymoma and the imaging features of advanced-stage thymoma to identify such patients before surgery.”
    Advances in Thymoma imaging
    Marom EM
    J Thorac Imaging 2013 28(2):69-80
  • Mediastinal Adenopathy: Differential Diagnosis
    - Lung cancer
    - Lymphoma
    - Metastatic disease (Renal Cancer is most common)
    - Sarcoidosis
    - TB
    - Castleman’s Disease
    - Histoplasmosis
  • “Mediastinal lymph node enlargements are caused most often by lymphoma, metastatic carcinoma, sarcoidosis, and infection, either directly by organisms, such as Mycobacterium tuberculosis, Histoplasma capsulatum, and others, or as a hyperplastic reaction to the presence of organisms within the lungs.”
    Evaluation of mediastinal lymph nodes using 18F-FDG PET-CT scan and its histopathologic correlation
    Kumar A et al.
    Ann Thorac Med. 2011 Jan-Mar; 6(1): 11–16.
  • “Pulmonary metastases usually appear as well-defined round or ovoid nodules on both chest radiography and CT. They can be solitary or multiple and typically range in size from 0.5 to 2 cm in diameter. They are one of the well-known causes of “cannonball” metastases. Pulmonary metastases are usually asymptomatic. Mediastinal lymph node involvement  is also a frequent finding and tends to involve the hilar, subcarinal, and paratracheal regions. Both large parenchymal lung and mediastinal lesions may show central necrosis.”
    Imaging in Metastatic Renal Cell Carcinoma
     Griffin N et al
    American Journal of Roentgenology. 2007;189: 360-370.
  • Lymphoma: Facts
    - Hodgkins is most common in the anterior mediastinum
    - Nodes rarely calcify unless the patient has undergone radiation therapy or occasionally chemotherapy
    - Parenchymal involvement at time of presentation is rare (under 10%)
    - Non-Hodgkin’s disease more commonly involves the lung parenchyma
  • Anterior Mediastinal Mass: Differential Diagnosis
    - Lymphoma
    - Germ cell tumor
    - Thymoma
    - Thyroid goiter
    - Inflammatory nodes like TB or Sarcoidosis
  • "CT and MR imaging of the thorax are helpful to characterize lesions initially identified at plain radiography. This characterization helps narrow the differential diagnosis when a lesion is detected in this location."

    Lesions of the Cardiophrenic Space: Findings at Cross Sectional Imaging
    Pineda V et al.
    RadioGraphics 2007; 27:19-32

  • Pericardial Cyst: Facts
    - More common in right cardiophrenic space (77%)
    - Congenital in origin
    - Always asymptomatic
    - Attenuation usually 0-20 HU
    - No enhancement on contrast enhanced studies
  • Lesions of the Cardiophrenic Space: Differential Diagnosis
    - Prominent cardiac fat pad
    - Diaphragmatic hernia (Morgagni hernia)
    - Pericardial fat necrosis
    - Pericardial cysts
    - Thymic tumors
    - Lymphoma
    - Adenopathy
  • Paraganglioma: Facts

    Paragangliomas are found predominantly in the abdomen (85%) and the thorax (12%), and only 3% are found in the head and neck region. Most occur as single tumors. When they occur in multiple sites they are usually found as a part of a heritable syndrome such as multiple endocrine neoplasia types II-A and II-B and SDH-related mutations.
  • Paraganglioma: Facts

    - Rare neuroendocrine tumors of chromaffin cell origin
    - When they arise outside the adrenal glands in extraadrenal neuroendocrine tissue they are called paragangliomas
    - May arise in the chest from the aortic body
  • Paraganglioma: Facts

    - Patients may have mutations in the mitochondrial II genes SDHB, SDHC and SDHD
    - 15% of these tumors are extra-adrenal, 85% adrenal in origin (pheochromocytoma)
  • Paragangliomas: CT Findings

    - Vasular lesions especially well enhanced on arterial phase imaging
    - Multiple lesions at multiple sites may be seen in select cases and may be part of a familial disorder as well
    - Carney syndrome- paraganglioma, pulmonary chondroma, and GI stromal tumor
  • Paragangliomas

    "Paragangliomas of the aortic body and the great vessels have a characteristic imaging appearance. They originate from known sites of the branchiomeric paraganglia such as the aortic body."

    Cross-Sectional Imaging of Paragangliomas of the Aortic Body and Other Thoracic Branchiomeric Paraganglia Balcombe J et al.
    AJR 2007; 188:1054-1058
  • Paragangliomas

    "Aortic body paragangliomas are accompanied by other synchronous paragangliomas in 10% of cases."

    Cross-Sectional Imaging of Paragangliomas of the Aortic Body and Other Thoracic Branchiomeric Paraganglia Balcombe J et al.
    AJR 2007; 188:1054-1058
  • Paragangliomas and Syndromes

    - Carney’s triad Paraganglioma, pulmonary chondroma, and GIST tumor
    - Hereditary Paraganglioma (J Med Genet 2002; 39:617-622)
  • Branchiomeric Paraganglia: Some Sites

    - Carotid body
    - Coronary paraganglia
    - Pulmonary paraganglia
    - Jugulotympanic paraganglia
    - Subclavian paraganglia
    - Laryngeal paraganglia
  • Extraadrenal Paragangliomas: CT Findings

    - Homogeneous or heterogeneous hyperenhancing mass
    - Range in size from 1 cm to over 20 cm
    - Common locations are carotid body, jugular foramen, aorticopulmonary region, posterior mediastinum, abdominal paraaortic region including Organ of Zuckerkandl, and pelvis
  • Paraganglioma: Facts

    - Neuroendocrine tumor which arises from the paraganglionic cells
    - Pheochromocytoma is a paraganglioma of the adrenal gland
    - Usually 4th and 5th decades of life
    - 10% are clinically silent and picked up incidentally
  • Paraganglioma: Facts

    - Familial Paragangliomas are 10% of cases
    - 35-50% of familial cases are multicentric
    - Occur with MEN IIA and IIB, tuberous sclerosis, neurofibromatosis, and von Hippel Lindau disease. Also part of Carney’s triad with gastric leiomyosarcoma, chondroma and extraadrenal paraganglioma
  • Paraganglioma: Facts

    "Although paragangliomas can occur in a variety of anatomic locations, the majority are seen in relatively predictable regions of the body."

    Extraadrenal Paragangliomas of the Body: imaging Features
    Lee KY et al.
    AJR 2006; 187:492-504
  • "Paragangliomas of the aortic body and the great vessels have a characteristic imaging appearance. They originate from known sites of the branchiomeric paraganglia such as in the aortic body."

    Cross-Sectional Imaging of Paragangliomas of the Aortic Body and Other Thoracic Branchiomeric Paraganglia
    Balcombe J et al.
    AJR 2007; 188:1054-1058
  • "Aortic body paragangliomas are accompanied by other synchronous paragangliomas in about 10% of cases."

    Cross-Sectional Imaging of Paragangliomas of the Aortic Body and Other Thoracic Branchiomeric Paraganglia
    Balcombe J et al.
    AJR 2007; 188:1054-1058
© 1999-2020 Elliot K. Fishman, MD, FACR. All rights reserved.