CTICasesMediastinal Synovial Cell Sarcoma
Imaging findings
Radiograph shows an opacity overlying the right hilum, a hilum overlay sign, and a second heart border. Lateral view demonstrates a well-defined mass filling the retrocardiac clear space. Initial CT from 2013 showed a heterogeneously enhancing mass in the middle mediastinum, abutting the posterior esophageal wall. Follow-up CT revealed a humongous mass with heterogeneous attenuation, probable necrosis, and calcification, demonstrating slow evolution over three years.
Key takeaways
Large, rapidly growing, and aggressive-appearing mediastinal masses, especially with heterogeneous enhancement, necrosis, and calcification, should raise suspicion for malignant etiologies, including rare sarcomas. The case highlights the slow but significant progression of such tumors over several years.
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