CTICasesPrimary Mediastinal Non-Hodgkin Lymphoma (Subtle Initial Radiograph)
Imaging findings
Initial chest radiograph in a young male shows a subtle interface abnormality at the right paratracheal border without clear mass visible on the lateral view. Follow-up radiograph several months later demonstrates interval development of a more conspicuous anterior mediastinal widening. CT confirms a large anterior mediastinal mass with multiple bilateral pulmonary nodules some containing air bronchograms.
Key takeaways
Large anterior mediastinal masses in young men are most commonly lymphoma (Hodgkin or non-Hodgkin) or germ cell tumor. Air bronchograms within pulmonary nodules favor lymphoma over germ cell metastases. Subtle mediastinal findings on a portable radiograph should not be dismissed, particularly in younger patients with persistent cough, as rapid interval growth of mediastinal lymphoma can occur.
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