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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 124-125

Unilateral opaque hemithorax secondary to teratoma


Department of Respiratory Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India

Date of Submission03-Sep-2021
Date of Decision24-Feb-2022
Date of Acceptance05-Mar-2022
Date of Web Publication12-May-2022

Correspondence Address:
Yogeshwari Manivannan
Department of Respiratory Medicine, PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_36_21

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  Abstract 


Mediastinal teratoma makes nearly 8%–13% of all mediastinal tumors, with peak incidence seen in young patients. A 26-year-old male presented with complaints of nonproductive cough, breathlessness, right side chest pain, and fever for 1-week duration. Chest X-ray showed homogeneous opacity of the right hemithorax with blunting of the right costophrenic angle. Contrast-enhanced computed tomography thorax showed multiloculated cystic lesion with the area of fat calcification in the right side of the upper mediastinum. Ultrasonography-guided biopsy shows feature suggestive of benign teratoma. Most teratoma tends to exhibit heterogeneous attenuation on computer tomography imaging.

Keywords: Computer tomography, heterogeneous attenuation, opaque hemithorax, teratoma


How to cite this article:
Manivannan Y, Murthy K A. Unilateral opaque hemithorax secondary to teratoma. J Assoc Pulmonologist Tamilnadu 2021;4:124-5

How to cite this URL:
Manivannan Y, Murthy K A. Unilateral opaque hemithorax secondary to teratoma. J Assoc Pulmonologist Tamilnadu [serial online] 2021 [cited 2022 Aug 8];4:124-5. Available from: http://www.japt.com/text.asp?2021/4/3/124/345080




  Introduction Top


The anterior mediastinal tumors include thymoma, lymphoma, metastasis, and teratoma. Mediastinal teratoma makes nearly up to 8%–13% of all mediastinal tumor, with peak incidence seen in young patients.[1]

The most common clinical presentation is dyspnea (25%), thoracic pain (23%), cough (17%), fever (13%), weight loss (11%), and superior vena cava occlusion (6%).[2] The anterior mediastinal teratoma presenting with pleural effusion is rare. The incidence is almost <2%.[3]

Mediastinal teratoma is commonly present radiologically as upper mediastinal widening, and computed tomography (CT) is considered the imaging modality of choice for the evaluation of these masses.[4]


  Case Report Top


A 26-year-old male presented with complaints of nonproductive cough, breathlessness, right side chest pain for 1-week duration, and fever for 10 days duration. On presentation, blood pressure – 110/70 mmhg, PR – 88/min, all peripheral pulses are felt equally. SpO2-98% @ RA. On examination, tracheal deviation to the left associated with dull note on percussion, decreased vocal fremitus, decreased vocal resonance, as well as decreased breath sound all over the right hemithorax. Routine blood investigations were within the normal limit. Chest radiography showed homogenous opacity of the right lung field with blunting of costophrenic angle, tracheal shift to the left. ECHO showed EF - 67%, pulmonary artery hypertension (rvsp – 60 mmhg), no RA, RV dilation. Ultrasound chest showed right-sided pleural effusion with consolidation of underlying lung [Figure 1]. Under strict aseptic precaution, with ultrasound guidance, pleural fluid was aspirated from the right pleural space. Pleural fluid analysis showed TC – 12,030, neutrophil – 80%, lymphocyte – 05%, macrophage – 13%, ADA – 83.3, glucose – 0.5, protein – 4.99, lactate dehydrogenase – 3721, and cytology – suppurative inflammation. Contrast-enhanced CT thorax showed multiloculated cystic lesion with enhancing wall with areas of fat, calcifications, no significant enhancing solid areas in the right side of the upper mediastinum extending from the level of thoracic inlet to paracardiac region abutting the diaphragm inferiorly, passive collapse of most of the right lung being pushed posteriorly, moderate right pleural fluid with thin enhancement in the parietal pleura around the right pleural fluid. Ultrasonography-guided biopsy was done from the right cystic lesion. The histopathology showed fragments of skeletal muscle bundle, adipose tissue, and fibrocollagenous tissue, few thick-walled blood vessels, and mild chronic infiltrate comprising lymphocytes and plasma cells are noted in the perivascular region. The features are suggestive of benign teratoma. The patient was taken up for surgical resection of tumor; biopsy confirmed the same.
Figure 1: Homogenous opacity of righth emithorax

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  Conclusion Top


Teratoma is tumors showing cells derived from all the three embryonic cell layers – ectoderm, mesoderm, and endoderm.[5] They arise from ectopic pluripotent stem cell that fails to migrate from gonads to the yolk endoderm. Teratoma may be mature: well differentiated, poorly differentiated, immature, or with malignant transformation.

Some studies have reported large mediastinal teratoma, manifesting as massive pleural effusion on chest radiographs, being invariably confirmed on CT imaging.[6] The diagnosis of mediastinal teratoma is often clinched based on the presence of fatty or calcified components within the mass – features are better appreciated on CT. Most teratoma tends to exhibit heterogeneous attenuation on CT imaging.[7]

Although CT imaging invariably confirms mediastinal teratomas, we found that large, predominantly cystic, mediastinal teratomas have the potential to mimic large pleural effusions even on CT. We need to exclude the underlying mediastinal mass in younger patients presenting with radiological evidence of opaque hemithorax.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

Thanks to the Department of Radiology and Pathology, PSG Institute of Medical Science and Research, Coimbatore.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
de Castro MA Jr., Rosemberg NP, de Castro MA, de Castro AP, Wietzycoscki C, Mespaque C. Mediastinal teratoma mimicking pleural effusion on chest X-rays. J Bras Pneumol 2007;33:113-5.  Back to cited text no. 1
    
2.
Santos PC, Maia CP, Pereira JC, Oliveira TC. Giant mediastinal teratoma found during surgery after thoracic trauma. Rev Bras Cir Cardiovasc 2007;22:252-4.  Back to cited text no. 2
    
3.
Bokemeyer C, Nichols CR, Droz JP, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: Results from an international analysis. J Clin Oncol 2002;20:1864-73.  Back to cited text no. 3
    
4.
Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: Imaging features. AJR Am J Roentgenol 1997;169:985-90.  Back to cited text no. 4
    
5.
Gonzalez-Crussi F. Extragonadal Teratomas: Atlas of Tumor Pathology. Vol. 18. Gonzalez crussi; 1982.  Back to cited text no. 5
    
6.
Sarkar A, Roy PP, Dey SK, Dwari AK, Bandyopadhyay R, Chakraborty K, et al. Mediastinal teratoma mimicking massive pleural effusion. J Assoc Physicians India 2010;58:453-5.  Back to cited text no. 6
    
7.
Park DR, Vallieres E. Tumors and cysts of the mediastinum. In: Murray and Nadel' s Textbook of Respiratory Medicine. Ch. 76. Murray and Nadel, 2016.  Back to cited text no. 7
    


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