CTICasesHigh-Flow Mediastinal Vascular Malformation
Imaging findings
An outside CT showed an avidly enhancing anterior/AP-window mediastinal mass fed by innumerable small vessels, which outside providers presumed to be lymphoma; mediastinoscopy and biopsy caused brisk, aorta-like bleeding, and surgical packing material is seen within the lesion on follow-up imaging. On dedicated dynamic imaging the mass blushes very early from a multitude of vessels arising directly off the aorta and washes out quickly, a pattern distinct from paraganglioma or vascular Castleman disease. Biopsy confirmed a true high-flow mediastinal vascular malformation.
Key takeaways
An avidly enhancing, richly vascular anterior mediastinal mass supplied by numerous small aortic branches should raise high-flow vascular malformation rather than lymphoma before biopsy, since these lesions can bleed dramatically like the aorta itself when sampled surgically; the differential for this appearance and location also includes paraganglioma and Castleman disease, but the degree of vascularity favors a vascular malformation, and terminology for these lesions (hemangioma versus vascular malformation) has shifted considerably over time.
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