Replying to Maria W. 15/08/2024 - 19:46
Hey Maria!
I have popped the CT report below to give you some more detail regarding the imaging:
CT Report for Lucky
Diagnostic Interpretation:
Neck/Spine C1 – T2:
The right mandibular and medial retropharyngeal lymph nodes are moderately enlarged compared to the left.
In the oropharynx, there is a lobulated soft tissue structure that homogenously contrast enhances (precontrast: 49.9 HU, postcontrast: 104.2 HU). This structure is confluent with the ventral margins of the soft palate and occupies almost the entire ventrodorsal height and mediolateral width of the oropharynx at the level of the hyoid apparatus. The remainder of the included head is unremarkable.
The superficial cervical and middle and caudal deep cervical lymph nodes are mildly enlarged.
No abnormalities are noted in the thyroid gland.
Thorax:
Centered in the cranial mediastinum is a large rounded lobulated soft tissue mass that mildly heterogeneously contrast enhances (precontrast: 39.4 HU, postcontrast: 82.6 HU). The mass measures approximately 15.6 cm craniocaudally, 10.7 cm dorsoventrally, and 7.4 cm mediolaterally, occupying almost the entire dorsoventral height and mediolateral width of the cranial thorax.
The mass extends cranially to the thoracic inlet and caudally to the left ventral aspect of the heart, displacing the heart dorsocaudally and towards the right.
The mass causes dorsal elevation of the trachea, cranial thoracic esophagus, and brachiocephalic trunk and its branches. The cranial vena cava is dorsally elevated and narrowed.
The visualized tracheobronchial and cranial mediastinal lymph nodes are moderately enlarged. The sternal lymph nodes are not distinguished from the mass.
There is a large volume of bilateral pleural effusion with accompanying retraction and rounding of the lung lobes. Throughout the lungs, there are patchy ground-glass to soft tissue attenuations, more pronounced ventrally, most consistent with atelectasis.
There is marked enlargement and rounding of the left proper axillary lymph node.
Mild subcutaneous fat stranding and fluid attenuation are seen along the ventral thoracic body wall and axilla.
Included Cranial Abdomen:
There is moderate enlargement and rounding of the hepatic, splenic, gastric, and celiac lymph nodes.
The liver is mildly to moderately enlarged with smooth margins and homogenous contrast enhancement. There is possible asymmetrical thickening of the gastric pylorus with questionable reduction in wall enhancement. Within the included mid aspect of the spleen, there is a small isoattenuating and hypercontrasting nodule.
The remainder of the included abdomen is unremarkable.
Moderate non-bridging spondylosis is seen in the cervical, thoracic, and lumbar spine. Mineralization and protrusion of multiple thoracic intervertebral discs are noted, with no overt spinal cord compression. In the vertebral body of T8, there is a rounded hypoattenuating region, most consistent with a Schmorl’s node. The remainder of the included musculoskeletal structures are unremarkable.
Conclusions:
Large cranial mediastinal mass.
Multiple variably enlarged lymph nodes (head, neck, thoracic, and abdominal).
Bilateral marked pleural effusion.
No evidence of nodular pulmonary metastasis.
Ventral thoracic and axillary subcutaneous fat stranding and fluid attenuation.
Possible oropharyngeal mass.
Hepatomegaly.
Hyperenhancing splenic nodule – benign, less likely malignant.
Questionable gastric pylorus wall thickening.
Additional Comments:
The large cranial mediastinal mass and generalized lymphadenopathy are concerning for lymphoma. Other cranial mediastinal neoplasms (e.g., thymic epithelial neoplasia, ectopic thyroid carcinoma) with lymph node metastasis and/or lymph node hyperplasia are also possible. Cranial mediastinal granuloma cannot be entirely excluded.
Ultrasound-guided sampling of the cranial mediastinal mass and affected lymph nodes (largest left axillary) is suggested for further characterization.
The bilateral pleural effusion can be due to neoplastic effusion, chyle, or less likely pus or hemorrhage. This can cause the reported panting and coughing. The rounded lung margins may suggest a chronic effusion. There is no evidence of nodular pulmonary metastasis, but this may be obscured by the suspected atelectasis.
Given the narrowed cranial vena cava, the subcutaneous fluid is suspected to be due to cranial vena cava syndrome (edema). A neoplastic effusion, cellulitis, or hemorrhage cannot be excluded. There is a possible oropharyngeal mass; however, this region is not entirely included in the field-of-view, and correlation with oral examination is suggested.
The questionable gastric wall thickening may be due to folding as this region is not completely included. Neoplastic infiltration or pyloric hypertrophy is possible. The hepatomegaly is nonspecific and can be due to a vacuolar hepatopathy, hepatitis, lymphoid hyperplasia, or less likely diffuse neoplasia. Clinical significance can be correlated with clinical history, and abdominal imaging can be performed if clinically indicated.
