Picture Quiz

Case history

A 30 year old student presented to an accident and emergency department with peluritic chest pain of six days' duration. He was previously well with no medical or surgical history. He was on no medication. Examination was unremarkable. An electrocardiogram was performed and this was normal. Figures 1 and 2 show the chest x ray film and the computerised tomography scan that were subsequently performed.

Questions

• (1) What does figure 1 show?

• (2) What is the differential diagnosis?

• (3) What does figure 2 show and how can a definitive diagnosis be reached?

Answers

• (1) Figure 1 shows mediastinal widening, most prominent in the superior mediastinum.

• (2) For descriptive convenience, mediastinal masses are conventionally divided into three compartments: anterior, middle, and posterior. The first step in evaluating a mass is to place it in …