Unusual Mediastinal Mass on Shoulder X-Ray
59th Medical Wing San Antonio United States
Pagination or Media Count:
INTRODUCTION Mediastinal masses found on routine imaging are common with an overall incidence of around one case per 100,000 persons per year. Endobronchial ultrasound fine needle aspiration EBUS-FNA is becomming a common tool to evaluate undifferentiated mediastianal masses. CASE PRESENTATION A 43-year-old female with right hemi-thyroidectomy five years prior was evaluated for one month of right shoulder pain, sensory changes and weakness. Shoulder x-ray demonstrated a large mass in the right upper lung field. Computer tomography CT demonstrated a well-circumscribed 12 x 8 x 9 cm heterogeneous mass with scattered calcifications which appeared to arise from the mediastinum. A new 2.5 cm left thyroid nodule was also identified on CT. The patient underwent EBUS-FNA of the mass with cytology consistent with benign thyroid tissue. Due to the size of the mass the patient underwent a second biopsy CT guided transthoracic FNA to further evaluate for isolated pockets of malignant thyroid tissue within the large mass. No malignant tissue was seen on either biopsy. Thoracic surgery completed a resection of the mass via median sternotomy. Final pathology was consistent with a benign multinodular goiter.
- Medicine and Medical Research
- Anatomy and Physiology