Posterior Mediastinal Mass

Fig. 1: Scout CT image shows a partially circumscribed posterior mediastinal mass (arrows) which was shown to be anterior to the spine on lateral scout view (image not shown).
Fig. 2: Axial CT image shows a mass to be entirely fat containing (arrows) located anterior to the spine, displacing the esophagus toward the left.

Facts: Posterior Mediastinal Mass

• Typical differential diagnostic approach utilizes the mass location on lateral view, whether it is projecting over the spine ("paraspinal") or anterior to the spine (but not over the heart)
• "Paraspinal" lesions have extensive differentials including neurogenic tumors, bone tumors (metastasis, myeloma), infection (abscess, discitis/osteomyelitis) and extramedullary hematopoiesis
• Lesions in another group have differential diagnoses of dilated esophagus, aorta (either unfolded, dilated or ruptured), hiatal hernia.

Our case: mediastinal lipoma

Reference:

Davies SG. Aids to Radiological Differential Diagnosis, 5th edition, 2009.