CT evaluation of mediastinal masses

CT is an important modality for imaging mediastinal masses, and certain CT attenuation features (fat, calcium, or water attenuation, contrast enhancement) are well known to suggest specific diagnoses. In a series of 132 consecutive patients with tissue-proven mediastinal masses, these specific CT features were present in only 16. We evaluated the ability of CT to differentiate soft tissue mediastinal masses based on morphology and distribution of disease. Metastatic disease and lymphoma accounted for 69% of masses in this series, and CT could not generally differentiate them. However, CT was helpful in differential diagnosis in certain settings. CT demonstration of multiple mediastinal masses when conventional radiographs showed a single mass generally excluded diagnoses such as thymoma and teratoma. CT demonstration of a single middle mediastinal mass, frequently missed by conventional radiography, made metastatic disease a much more likely diagnosis than lymphoma. Finally, CT demonstration of certain ancillary findings strongly favored a diagnosis of lymphoma (axillary adenopathy) or metastatic disease (solitary pulmonary mass, focal liver lesions, bone lesions).