40yo with cough. Where is the mass located? Likely diagnosis?
Anterior mediastinal mass in a 40yo woman with cough. You can tell the mass is anterior on this chest x-ray due to silhouettes. The descending aorta remains visible meaning the mass cannot be posterior. The left hilar vessels remain visible (hilum overlay sign) meaning the mass cannot be at the hilum. The upper left heart border silhouette however is lost confirming the mass must be anterior. Biopsy proved this mass to be lymphoma.
Pulmonary emphysema refers to destruction of alveolar spaces without fibrosis and occurs in several patterns. Centrilobular emphysema develops at the centre of the secondary pulmonary lobule and is the most common form seen in smokers. Panlobular emphysema refers to alveolar destruction throughout the secondary pulmonary lobule and is typical of alpha-1-antitrypsin deficiency. Paraseptal emphysema occurs along the interlobular septae and particularly the pleural margin. Often all patterns can be seen in the same lung, as with this HRCT example.
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