Question

A soft tissue density lesion was found in the posterior mediastinum, adjacent to the spine on the right side of the thoracic cavity, with a CT value of approximately 36 Hu. The lesion has a smooth margin and is connected to the spine and the posterior chest wall. Additionally, the T2-3 intervertebral foramen is slightly enlarged but without obvious structural destruction. The lesion shows uneven uptake on the radionuclide scan, with an SUVmax of 1.8. A small nodule is also seen in the lower lobe of the right lung, with normal radionuclide distribution. There is increased radionuclide uptake in the thymic region of the mediastinum, with an SUVmax of 3.5, and no enlarged lymph nodes are observed. Multiple lymph nodes of varying sizes are present in both axillary fossae, with the largest measuring approximately 0.8cm x 1.0cm, and with normal radionuclide distribution. What is the diagnosis?

Answer

Considerations for diagnosis include:

  1. A soft tissue lesion adjacent to the spine in the right posterior mediastinum, with mild metabolic increase, suspected to be a neuronal tumor, possibly compressing the T2-3 intervertebral foramen, requiring confirmation with clinical data.
  2. Multiple lymph nodes in both axillary fossae, with normal metabolic activity, possibly indicative of inflammatory hyperplasia, requiring confirmation with clinical data.
  3. A small nodule in the lower lobe of the right lung, with normal metabolic activity, recommended for regular follow-up.
  4. Sinusitis and hypertrophy of nasopharyngeal mucosa.