CTICasesSmall B-Cell Lymphoma Presenting as Confluent Posterior Mediastinal/Paravertebral Soft Tissue
Imaging findings
A middle-aged woman with B symptoms and a right pleural effusion had non-contrast CT showing confluent bilateral paravertebral soft tissue draping over the vertebral bodies in the posterior mediastinum, raising a differential of lymphadenopathy, extramedullary hematopoiesis, granulomatous infection, or myeloid/lymphoid neoplasm; contrast-enhanced imaging showed the soft tissue lifting the aorta off the spine (similar to a retroperitoneal lymphomatous mass), extension into the paraspinal muscles and anterior mediastinal fat, and enlarged axillary lymph nodes, which were biopsied and confirmed small B-cell lymphoma; spine MRI additionally showed enhancing tumor extending into the central canal at multiple levels with resultant narrowing.
Key takeaways
Confluent paravertebral/posterior mediastinal soft tissue that lifts the aorta off the spine, analogous to the appearance of retroperitoneal lymphoma, should raise lymphoma in the differential alongside infection and extramedullary hematopoiesis, and identifying a more accessible biopsy site such as an enlarged axillary lymph node can avoid a more invasive paravertebral biopsy; because paravertebral tumor can extend into the spinal canal, dedicated spine MRI should be obtained to assess for canal narrowing whenever disease drapes along the paravertebral region.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Mixed Fungal Infection with Mucormycosis "Bird's Nest" Sign, Aspergillus Abscess, and CandidaInfection
- Donor-Derived Respiratory Bronchiolitis After Single Lung TransplantILD
- Synchronous Adenocarcinoma, Carcinoid Tumor, and Pulmonary Langerhans Cell Histiocytosis in the Same LobeNeoplastic
- Pleural Tuberculosis Mimicking Malignant Pleural Spread over Several YearsInfection
- Localized (Unilobar) Allergic Bronchopulmonary AspergillosisInflammatory
- Acute Eosinophilic Pneumonia of Undetermined CauseILD
- Hypersensitivity Pneumonitis Demonstrated by the "Gray Lung" Window/Level SignILD
- Intrathoracic (Mediastinal) Ectopic Thyroid Tissue Displacing the TracheaOther
See all cases from June 15, 2018 →
Related Neoplastic cases
- Computer-Aided Detection (CAD) Miss of a Right Upper Lobe Lung Cancer
- Massive Endovascular Metastases from Renal Cell Carcinoma
- Severe Pulmonary Lymphangitic Carcinomatosis from Gastric Cancer
- Right Lower Lobe Nodule with Equivocal Fat Attenuation Mimicking Hamartoma
- Calcified Mid-Lung Nodule Mimicking Hamartoma with Nodal Metastasis
- Primary Mediastinal Large B-Cell Lymphoma