CTICasesGanglioneuroma (Cystic Posterior Mediastinum)
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Imaging findings
A mediastinal mass is seen, primarily in the superior mediastinum and lower neck, causing a leftward shift of the trachea. On CT, the mass has largely fluid attenuation but with heterogeneous contents, suggesting it is not a simple duplication cyst. MRI demonstrates heterogeneous signal, being slightly hypointense on T1 and higher intensity on T2 imaging, with definite soft tissue elements. Biopsy confirmed a ganglioneuroma. Some areas on CT show attenuation values around 10-12 HU, consistent with the myxoid and fibrotic stroma and schwannian elements described in these tumors. Radiographically, the mass produces an inferior and sharp interface with the lung in the apical chest, consistent with a lesion arising primarily in the apical and posterior hemithorax (the 'anti-cervicothoracic sign').
Key takeaways
Ganglioneuromas are benign nerve sheath tumors typically found in the posterior mediastinum. They can have a cystic or heterogeneous appearance due to myxoid and fibrotic stroma, which can result in low attenuation on CT. Imaging characteristics on MRI further delineate their tissue composition. Radiographic signs, such as the anti-cervicothoracic sign, can help localize the origin of a mediastinal mass.
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