CTICasesAcutely Enlarging Thymic Cyst in a Transplant Patient
Imaging findings
Serial radiographs in a bone marrow transplant candidate being treated for leukemia show a mediastinum that was normal in late December then rapidly developed bilateral convexity and a large anterior mediastinal mass over about one week, without catheter manipulation. CT shows a uniform anterior mediastinal lesion of roughly 23 Hounsfield units lying anterior to and separate from the pericardium, with minimal surrounding fat stranding and fairly sharp margins. An earlier CT showed essentially no thymic tissue.
Key takeaways
A rapidly appearing, uniform, low-attenuation anterior mediastinal mass in an immunosuppressed transplant patient prompts consideration of PTLD, EBV/IRIS-associated disease, Castleman disease, or hematoma, but needle biopsy here yielded thymic epithelial cells consistent with a thymic cyst. Exuberant rebound thymic change may acutely enlarge a thymic cyst, an unusually rapid and florid presentation, and short-interval follow-up showed the lesion beginning to regress.
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