Discrepancies between X-Ray Results and Cytology in the Case of an Anterior Mediastinal Mass in a 21-year-old Man

Abstract

The development of malignancy in the mediastinum can occur from anatomically situated structures within or across the mediastinum, and metastases or malignancy can also come from other regions of the body. Blood veins, fat, lymph nodes, and the thymus are all located in the anterior mediastinum. Mr. S, a 21-year-old man, came to RSAM that he had been having trouble breathing for two weeks. The patient first only felt cold and fever in his body. Later, when lying down in his room, the patient started to feel short of breath. The shortness of breath was particularly felt in the middle of the chest, got worse while the patient was lying down, and got better when he was sitting. Additional complaints from patients include weight loss, nocturnal sweats, a dry cough without phlegm, and chest pain. On physical examination, the chest's Intracostal inspection was asymmetrical, and there were enlarged cervical lymph nodes. Right chest palpation revealed dull percussion and decreased tactile fremitus, while right chest auscultation revealed fewer vesicles. An impression of a bilateral lower paratracheal to hilar mediastinal mass was seen on the patient's plain chest X-ray with PA projection, raising the possibility of malignant lymphoma. It can be concluded from the history, physical examination, and plain chest X-ray that the mediastinal mass leads to Mediastinal Hodgkin's Lymphoma. However, cytology results showed no malignant tumor cells. Therefore, accurate further examination is needed, namely a biopsy