CTICasesPosterior Mediastinal Schwannoma
Imaging findings
A PA radiograph reveals a curvilinear opacity projecting over the right hemidiaphragm, which is a potential blind spot. The lateral view confirms its posterior and medial location. CT demonstrates a complex, bilobed mass of intermediate attenuation that has remodeled and scalloped the adjacent vertebral body, indicating chronicity. The mass is retrocrural, situated at the transition between the middle and posterior mediastinum, without evidence of splaying of the ribs or enlargement of the intervertebral foramen. The crus of the diaphragm is draped over the mass.
Key takeaways
A schwannoma can present in the posterior mediastinum, mimicking other entities like diaphragmatic eventration or hernia on plain radiographs. Vertebral body remodeling is a valuable clue to the chronicity of such lesions. When evaluating masses in this particular location, one should consider processes extending from the abdomen into the chest, often referred to as variations of the thoracoabdominal sign. Schwannomas in this area can be highly adherent to vertebral bodies, potentially necessitating their resection.
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