CTICasesMediastinal Lymphoma in the Azigoesophageal Recess
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Imaging findings
Frontal chest radiograph reveals a subtle but abnormal contour of the azigoesophageal recess, demonstrated by an increased opacity and a lateralized interface in the subcarinal and lower paraspinal region. The lateral radiograph shows abnormal opacity filling the inferior hilar triangle and obscuring the posterior wall of the bronchus intermedius. PET/CT confirms a very large, highly FDG-avid subcarinal and posterior mediastinal mass, histopathologically proven to be lymphoma.
Key takeaways
The azigoesophageal recess is a critical mediastinal interface that must be systematically evaluated on every chest radiograph. Masses in this region (including lymphadenopathy from lymphoma, lung cancer, or sarcoidosis) can grow quite large before detection if the interface is not carefully analyzed. On the lateral view, the "inferior hilar triangle" should normally be radiolucent; any opacity in this area, or thickening/obscuration of the posterior wall of the bronchus intermedius, is highly sensitive for a subcarinal or posterior mediastinal mass.
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