CTICasesPrimary Mediastinal Large B-Cell Lymphoma
Imaging findings
A large anterior mediastinal mass shows areas of low attenuation consistent with necrosis, growing between the brachiocephalic vessels and narrowing the innominate vein, with associated upper chest wall soft tissue edema and posterior displacement of adjacent structures. There is diffuse body edema, pleural fluid, and pericardial fluid. PET imaging shows intense FDG uptake within the mediastinal mass as well as an FDG-avid right lung apex lesion.
Key takeaways
The clinical and imaging picture raised concern for either lymphoma or NUT midline carcinoma. Biopsy in this relatively young patient confirmed large B-cell lymphoma, similar to a prior case the presenter had recently seen, reinforcing large B-cell lymphoma as a common cause of a large necrotic anterior mediastinal mass with venous-compression symptoms in a young patient.
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