CTICasesMediastinal Large B-Cell Lymphoma Demonstrating the Hilum Overlay Sign
Imaging findings
Chest radiograph shows a large anterior mediastinal opacity through which the right pulmonary artery and paratracheal stripe remain visible, a positive hilum overlay sign confirming the mass is not truly hilar. CT shows a large, heterogeneously enhancing anterior mediastinal mass with only mild associated right paratracheal lymphadenopathy and no significant nodal disease outside the chest.
Key takeaways
A hilum overlay sign helps localize a large mediastinal mass as non-hilar (here, a primary mediastinal large B-cell lymphoma); the relative paucity of extrathoracic nodal disease and lack of vascular encasement helped distinguish this from midline NUT carcinoma, which was also considered given recent similar cases.
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