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Joseph Junewick, MD FACR
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Middle mediastinal mass secondary to aneurysm of aorticopulmonary collateral

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 8 years ago
Updated: 8 months ago
Tags: CHEST
Modality/Study Types: CR CT
Activities:
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History

39 year old male with back pain after fall.


Case Images


Diagnosis

Aneurysm of aorticopulmonary collateral.

Findings

CXR – rounded right mid-thoracic paraspinal mass

CT – atherosclerosis and mural thrombus associated with aneurysmal dilation of a aorticopulmonary collateral artery.

Discussion

The azygoesophageal recess is the interface between the right lung and the mediastinal reflection inferior to the arch of the azygos vein, with the esophagus lying anteriorly and the azygos vein posteriorly within the mediastinum. At radiography, this interface is seen as an edge, occasionally with a right convex bulge along the mid portion related to the right pulmonary vein confluence. Differential considerations for a lesion in this area would be duplication or bronchogenic cyst, cardiac or pericardial abnormality, adnenopathy, and vascular anomaly. The usual vascular anomaly in this middle mediastinal mass differential would be for aortic aneurysm, however this case represents an unusual vascular consideration.

Reference

Written CR, Khan S, Munneke GJ et al. A Diagnostic Approach to Mediastinal Abnormalities. RadioGraphics (2007); 27:657– 671



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