PMC6260451_01
Chest X-ray. A large right-sided mediastinal mass obscured the cardiac border.
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A chest X-ray demonstrated a large right-sided mediastinal mass that obscured the cardiac border (Fig. 1), and unenhanced chest CT showed a smoothly marginated huge mass extending from the upper mediastinum to the level of the diaphragm, and the mass also extended from the anterior to the posterior mediastinum at the level of the diaphragm (Fig. 2A-C).
Chest CT images. A-C: Unenhanced chest CT images. The smoothly marginated huge mass extended from the upper mediastinum to the level of the diaphragm, and also from the anterior to the posterior mediastinum at the level of the diaphragm. Punctate calcific opacities within the mass were identified (arrows on B). D-F: Contrast-enhanced CT images. The mass demonstrated nodular and tubular enhancing structures, fat attenuation, and multiple scattered calcifications. The flow of contrast medium from the SVC into the mass was also identified (arrow on D). In the spleen, multiple thin-walled low-attenuation masses with no enhancement located at the subcapsular region were observed.
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Furthermore, in the spleen, multiple thin-walled low-attenuation masses with no enhancement located at the subcapsular region were observed (Fig. 2D-F).
Chest MRI images. A-C: T1-weighted MRI. The lesion appeared as a heterogeneous mass of predominantly intermediate signal intensity. D-F: T2-weighted MRI. The lesion appeared as a hyperintense mass with a flow void that was thought to represent an enlarged vein draining into IVC (arrow on E). G-I: Contrast-enhanced T1-weighted MRI. Multiple tortuous serpentine enhanced structures and enlarged veins draining into SVC (black arrow on G) and IVC (arrow on H) were demonstrated. A part of the mass was multilocular and marginally enhanced (white arrows on G).
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On T1-weighted MRI, the lesion appeared as a heterogeneous mass of predominantly intermediate signal intensity (Fig. 3A-C), and on T2-weighted MRI, it appeared as a hyperintense mass with a flow void that was thought to represent an enlarged vein draining into the inferior vena cava (IVC) (Fig. 3D-F). A part of the mass was multilocular and marginally enhanced (Fig. 3G-I).