CTICasesThymic Cholesterol Cleft Granuloma
Imaging findings
Chest CT shows a multi-nodular soft-tissue mass in the anterior mediastinum with interdigitating fat. PET CT demonstrates moderate metabolic activity within the mass with an SUV max of 4.8. Histopathological analysis of the resected specimen reveals cholesterol clefts, foreign body giant cells, and granulomatous reaction within mature thymic tissue.
Key takeaways
Thymic cholesterol cleft granuloma is a rare, benign, tumor-like inflammatory lesion of the thymus that can mimic a thymoma or thymic malignancy due to its nodular appearance and FDG-avidity. It is believed to represent a chronic, foreign-body-like granulomatous reaction to localized thymic tissue injury or a ruptured thymic cyst.
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