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Imaging of Cystic Masses of the Mediastinum¹

¹ From the Departments of Radiology B (M.Y.J., A.G., D.C., C.R.), Pathology (B.G.), Radiology 2 (A.B., J.L.D.), and Thoracic Surgery (J.M.W.), University Hospital of Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg, France. Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received February 25, 2002; revision requested March 28 and received May 30; accepted June 12. Address correspondence to M.Y.J. (e-mail: Mi-Young.Jeung@chru-strasbourg.fr).

View larger version (120K): [in a new window]   Figure 1a.  Typical benign pericardial cyst with serous content in a 46-year-old woman. (a) Coronal T1-weighted MR image shows a round low-signal-intensity cyst with a regular thin wall. (b) T2-weighted MR image shows a homogeneous high-signal-intensity cyst without septation or a mural nodule.

View larger version (134K): [in a new window]   Figure 1b.  Typical benign pericardial cyst with serous content in a 46-year-old woman. (a) Coronal T1-weighted MR image shows a round low-signal-intensity cyst with a regular thin wall. (b) T2-weighted MR image shows a homogeneous high-signal-intensity cyst without septation or a mural nodule.

View larger version (143K): [in a new window]   Figure 2a.  Bronchogenic cyst in a 49-year-old man with a 2-week history of fever and cough. (a) Chest radiograph shows a round mass (arrow) that displaces the right primary bronchus superiorly, as well as pneumonia of the middle lobe and pleural effusion. (b) Contrast material-enhanced CT scan shows a cyst with uniform water attenuation and with an imperceptible wall. (c) Sagittal T1-weighted MR image shows a high-signal-intensity cyst with a fluid-fluid level due to infection (arrow). (d) Photomicrograph (original magnification, x50; hematoxylin-eosin [H-E] stain) shows a portion of the cyst wall with respiratory epithelium (arrow) that overlies fibrous tissue and cartilage.

View larger version (93K): [in a new window]   Figure 2b.  Bronchogenic cyst in a 49-year-old man with a 2-week history of fever and cough. (a) Chest radiograph shows a round mass (arrow) that displaces the right primary bronchus superiorly, as well as pneumonia of the middle lobe and pleural effusion. (b) Contrast material-enhanced CT scan shows a cyst with uniform water attenuation and with an imperceptible wall. (c) Sagittal T1-weighted MR image shows a high-signal-intensity cyst with a fluid-fluid level due to infection (arrow). (d) Photomicrograph (original magnification, x50; hematoxylin-eosin [H-E] stain) shows a portion of the cyst wall with respiratory epithelium (arrow) that overlies fibrous tissue and cartilage.

View larger version (155K): [in a new window]   Figure 2c.  Bronchogenic cyst in a 49-year-old man with a 2-week history of fever and cough. (a) Chest radiograph shows a round mass (arrow) that displaces the right primary bronchus superiorly, as well as pneumonia of the middle lobe and pleural effusion. (b) Contrast material-enhanced CT scan shows a cyst with uniform water attenuation and with an imperceptible wall. (c) Sagittal T1-weighted MR image shows a high-signal-intensity cyst with a fluid-fluid level due to infection (arrow). (d) Photomicrograph (original magnification, x50; hematoxylin-eosin [H-E] stain) shows a portion of the cyst wall with respiratory epithelium (arrow) that overlies fibrous tissue and cartilage.

View larger version (145K): [in a new window]   Figure 2d.  Bronchogenic cyst in a 49-year-old man with a 2-week history of fever and cough. (a) Chest radiograph shows a round mass (arrow) that displaces the right primary bronchus superiorly, as well as pneumonia of the middle lobe and pleural effusion. (b) Contrast material-enhanced CT scan shows a cyst with uniform water attenuation and with an imperceptible wall. (c) Sagittal T1-weighted MR image shows a high-signal-intensity cyst with a fluid-fluid level due to infection (arrow). (d) Photomicrograph (original magnification, x50; hematoxylin-eosin [H-E] stain) shows a portion of the cyst wall with respiratory epithelium (arrow) that overlies fibrous tissue and cartilage.

View larger version (93K): [in a new window]   Figure 3a.  Bronchogenic cyst in a 44-year-old woman with a 3-year history of chest pain. (a) CT scan shows a thin-walled water-attenuation cyst in the posterior mediastinum (arrow). (b) Videothoracoscopic image shows a translucent round cyst behind the descending aorta (arrow).

View larger version (111K): [in a new window]   Figure 3b.  Bronchogenic cyst in a 44-year-old woman with a 3-year history of chest pain. (a) CT scan shows a thin-walled water-attenuation cyst in the posterior mediastinum (arrow). (b) Videothoracoscopic image shows a translucent round cyst behind the descending aorta (arrow).

View larger version (104K): [in a new window]   Figure 4.  Bronchogenic cyst in a 37-year-old asymptomatic woman. Coronal T1-weighted MR image shows a cyst with high-signal-intensity contents (arrow).

View larger version (137K): [in a new window]   Figure 5a.  Duplication cyst in a 10-year-old girl with cough. (a) Chest radiograph shows a round area of increased opacity that deforms the azygoesophageal recess (arrow). (b) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst adjacent to the esophagus (arrow).

View larger version (115K): [in a new window]   Figure 5b.  Duplication cyst in a 10-year-old girl with cough. (a) Chest radiograph shows a round area of increased opacity that deforms the azygoesophageal recess (arrow). (b) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst adjacent to the esophagus (arrow).

View larger version (105K): [in a new window]   Figure 6a.  Pericardial cyst in a 37-year-old asymptomatic man. (a) Chest radiograph shows a sharply defined area of increased opacity in the right cardiophrenic angle (arrow). (b) US image shows a well-defined anechoic cyst that connects to the pericardium (arrow). (c) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (d) Photomicrograph (original magnification, x100; H-E stain) shows a cyst wall composed of a thin layer of fibrous tissue lined with a single layer of mesothelial cells (arrow).

View larger version (114K): [in a new window]   Figure 6b.  Pericardial cyst in a 37-year-old asymptomatic man. (a) Chest radiograph shows a sharply defined area of increased opacity in the right cardiophrenic angle (arrow). (b) US image shows a well-defined anechoic cyst that connects to the pericardium (arrow). (c) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (d) Photomicrograph (original magnification, x100; H-E stain) shows a cyst wall composed of a thin layer of fibrous tissue lined with a single layer of mesothelial cells (arrow).

View larger version (112K): [in a new window]   Figure 6c.  Pericardial cyst in a 37-year-old asymptomatic man. (a) Chest radiograph shows a sharply defined area of increased opacity in the right cardiophrenic angle (arrow). (b) US image shows a well-defined anechoic cyst that connects to the pericardium (arrow). (c) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (d) Photomicrograph (original magnification, x100; H-E stain) shows a cyst wall composed of a thin layer of fibrous tissue lined with a single layer of mesothelial cells (arrow).

View larger version (158K): [in a new window]   Figure 6d.  Pericardial cyst in a 37-year-old asymptomatic man. (a) Chest radiograph shows a sharply defined area of increased opacity in the right cardiophrenic angle (arrow). (b) US image shows a well-defined anechoic cyst that connects to the pericardium (arrow). (c) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (d) Photomicrograph (original magnification, x100; H-E stain) shows a cyst wall composed of a thin layer of fibrous tissue lined with a single layer of mesothelial cells (arrow).

View larger version (104K): [in a new window]   Figure 7a.  Lateral thoracic meningocele in a 37-year-old man with neurofibromatosis. (a) CT scan shows a low-attenuation mass protruding from the enlarged left intervertebral foramen. (b) On a myelogram, contrast medium is seen to pass into the meningocele (arrow).

View larger version (106K): [in a new window]   Figure 7b.  Lateral thoracic meningocele in a 37-year-old man with neurofibromatosis. (a) CT scan shows a low-attenuation mass protruding from the enlarged left intervertebral foramen. (b) On a myelogram, contrast medium is seen to pass into the meningocele (arrow).

View larger version (131K): [in a new window]   Figure 8a.  Thymic cyst in a 70-year-old asymptomatic woman. (a) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (b) Sagittal T1-weighted MR image shows a low-signal-intensity cyst (arrow) in a thymic location. (c) Photograph obtained at surgery shows a translucent round cyst protruding from the thorax.

View larger version (142K): [in a new window]   Figure 8b.  Thymic cyst in a 70-year-old asymptomatic woman. (a) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (b) Sagittal T1-weighted MR image shows a low-signal-intensity cyst (arrow) in a thymic location. (c) Photograph obtained at surgery shows a translucent round cyst protruding from the thorax.

View larger version (144K): [in a new window]   Figure 8c.  Thymic cyst in a 70-year-old asymptomatic woman. (a) Contrast-enhanced CT scan shows a thin-walled water-attenuation cyst (arrow). (b) Sagittal T1-weighted MR image shows a low-signal-intensity cyst (arrow) in a thymic location. (c) Photograph obtained at surgery shows a translucent round cyst protruding from the thorax.

View larger version (104K): [in a new window]   Figure 9.  Mature cystic teratoma in a 35-year-old man. Photograph of a bisected tumor shows a thick-walled cyst containing a bulk of hair (arrow).

View larger version (115K): [in a new window]   Figure 10a.  Mature cystic teratoma in a 31-year-old man who had chest discomfort and dyspnea at exertion. (a) Radiograph shows a large, well-defined mediastinal mass (arrow). (b) Contrast-enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (long arrow), calcification (short arrow), fluid attenuation, and thin soft-tissue septa. (c, d) T1-weighted (c) and T2-weighted (d) MR images show a mass with a high-signal-intensity area of fat (arrow), low-signal-intensity calcification, and a high-signal-intensity multilocular cyst. (e) Photograph of the surgical specimen shows an oval mass with sebaceous material (long arrow), cartilage, and nerve tissue (short arrow).

View larger version (116K): [in a new window]   Figure 10b.  Mature cystic teratoma in a 31-year-old man who had chest discomfort and dyspnea at exertion. (a) Radiograph shows a large, well-defined mediastinal mass (arrow). (b) Contrast-enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (long arrow), calcification (short arrow), fluid attenuation, and thin soft-tissue septa. (c, d) T1-weighted (c) and T2-weighted (d) MR images show a mass with a high-signal-intensity area of fat (arrow), low-signal-intensity calcification, and a high-signal-intensity multilocular cyst. (e) Photograph of the surgical specimen shows an oval mass with sebaceous material (long arrow), cartilage, and nerve tissue (short arrow).

View larger version (147K): [in a new window]   Figure 10c.  Mature cystic teratoma in a 31-year-old man who had chest discomfort and dyspnea at exertion. (a) Radiograph shows a large, well-defined mediastinal mass (arrow). (b) Contrast-enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (long arrow), calcification (short arrow), fluid attenuation, and thin soft-tissue septa. (c, d) T1-weighted (c) and T2-weighted (d) MR images show a mass with a high-signal-intensity area of fat (arrow), low-signal-intensity calcification, and a high-signal-intensity multilocular cyst. (e) Photograph of the surgical specimen shows an oval mass with sebaceous material (long arrow), cartilage, and nerve tissue (short arrow).

View larger version (134K): [in a new window]   Figure 10d.  Mature cystic teratoma in a 31-year-old man who had chest discomfort and dyspnea at exertion. (a) Radiograph shows a large, well-defined mediastinal mass (arrow). (b) Contrast-enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (long arrow), calcification (short arrow), fluid attenuation, and thin soft-tissue septa. (c, d) T1-weighted (c) and T2-weighted (d) MR images show a mass with a high-signal-intensity area of fat (arrow), low-signal-intensity calcification, and a high-signal-intensity multilocular cyst. (e) Photograph of the surgical specimen shows an oval mass with sebaceous material (long arrow), cartilage, and nerve tissue (short arrow).

View larger version (91K): [in a new window]   Figure 10e.  Mature cystic teratoma in a 31-year-old man who had chest discomfort and dyspnea at exertion. (a) Radiograph shows a large, well-defined mediastinal mass (arrow). (b) Contrast-enhanced CT scan shows a heterogeneous anterior mediastinal mass with areas of fat (long arrow), calcification (short arrow), fluid attenuation, and thin soft-tissue septa. (c, d) T1-weighted (c) and T2-weighted (d) MR images show a mass with a high-signal-intensity area of fat (arrow), low-signal-intensity calcification, and a high-signal-intensity multilocular cyst. (e) Photograph of the surgical specimen shows an oval mass with sebaceous material (long arrow), cartilage, and nerve tissue (short arrow).

View larger version (141K): [in a new window]   Figure 11a.  Lymphangioma in a 35-year-old man with a history of multiple resections of cystic hygroma since infancy. (a) Chest radiograph shows a large mediastinal mass. (b) Contrast-enhanced CT scan shows a low-attenuation mass (arrow) that extends to all mediastinal compartments. (c) Coronal T2-weighted MR image shows a high-signal-intensity cystic mass with multiple septa (arrows).

View larger version (132K): [in a new window]   Figure 11b.  Lymphangioma in a 35-year-old man with a history of multiple resections of cystic hygroma since infancy. (a) Chest radiograph shows a large mediastinal mass. (b) Contrast-enhanced CT scan shows a low-attenuation mass (arrow) that extends to all mediastinal compartments. (c) Coronal T2-weighted MR image shows a high-signal-intensity cystic mass with multiple septa (arrows).

View larger version (148K): [in a new window]   Figure 11c.  Lymphangioma in a 35-year-old man with a history of multiple resections of cystic hygroma since infancy. (a) Chest radiograph shows a large mediastinal mass. (b) Contrast-enhanced CT scan shows a low-attenuation mass (arrow) that extends to all mediastinal compartments. (c) Coronal T2-weighted MR image shows a high-signal-intensity cystic mass with multiple septa (arrows).

View larger version (120K): [in a new window]   Figure 12a.  Cystic thymoma in a 50-year-old man with a 2-month history of myasthenia. (a) Contrast-enhanced CT scan shows a solid mass (arrow) in a thymic location. (b) CT scan obtained at a lower level than a shows a thin-walled water-attenuation cystic lesion. (c) Sagittal T2-weighted MR image shows a thin-walled high-signal-intensity cystic lesion with mural nodules (arrow). The nodules are better seen at MR imaging than at CT. (d) Photograph of the resected surgical specimen shows a thymoma with cystic degeneration and solid mural nodules.

View larger version (112K): [in a new window]   Figure 12b.  Cystic thymoma in a 50-year-old man with a 2-month history of myasthenia. (a) Contrast-enhanced CT scan shows a solid mass (arrow) in a thymic location. (b) CT scan obtained at a lower level than a shows a thin-walled water-attenuation cystic lesion. (c) Sagittal T2-weighted MR image shows a thin-walled high-signal-intensity cystic lesion with mural nodules (arrow). The nodules are better seen at MR imaging than at CT. (d) Photograph of the resected surgical specimen shows a thymoma with cystic degeneration and solid mural nodules.

View larger version (109K): [in a new window]   Figure 12c.  Cystic thymoma in a 50-year-old man with a 2-month history of myasthenia. (a) Contrast-enhanced CT scan shows a solid mass (arrow) in a thymic location. (b) CT scan obtained at a lower level than a shows a thin-walled water-attenuation cystic lesion. (c) Sagittal T2-weighted MR image shows a thin-walled high-signal-intensity cystic lesion with mural nodules (arrow). The nodules are better seen at MR imaging than at CT. (d) Photograph of the resected surgical specimen shows a thymoma with cystic degeneration and solid mural nodules.

View larger version (107K): [in a new window]   Figure 12d.  Cystic thymoma in a 50-year-old man with a 2-month history of myasthenia. (a) Contrast-enhanced CT scan shows a solid mass (arrow) in a thymic location. (b) CT scan obtained at a lower level than a shows a thin-walled water-attenuation cystic lesion. (c) Sagittal T2-weighted MR image shows a thin-walled high-signal-intensity cystic lesion with mural nodules (arrow). The nodules are better seen at MR imaging than at CT. (d) Photograph of the resected surgical specimen shows a thymoma with cystic degeneration and solid mural nodules.

View larger version (111K): [in a new window]   Figure 13.  Hodgkin disease in a 16-year-old girl with a 1-month history of chest pain and general weakness. Axial T2-weighted MR image shows a mass with mixed solid and cystic components (arrow).

View larger version (101K): [in a new window]   Figure 14a.  Recurrent choriocarcinoma in a 37-year-old man who had undergone radiation therapy and chemotherapy 4 years earlier. Contrast-enhanced CT scan (a) and T2-weighted MR image (b) show a lobulated mass with mixed solid and cystic components (arrow in b) in the anterior mediastinum.

View larger version (148K): [in a new window]   Figure 14b.  Recurrent choriocarcinoma in a 37-year-old man who had undergone radiation therapy and chemotherapy 4 years earlier. Contrast-enhanced CT scan (a) and T2-weighted MR image (b) show a lobulated mass with mixed solid and cystic components (arrow in b) in the anterior mediastinum.

View larger version (141K): [in a new window]   Figure 15a.  Cystic schwannoma in a 17-year-old asymptomatic boy. (a) Chest radiograph shows a well-defined round mass (arrow) in the left part of the superior mediastinum. (b) Contrast-enhanced CT scan shows a thin-walled low-attenuation cystic lesion in the paravertebral region. (c) Axial T2-weighted MR image shows a homogeneous high-signal-intensity cystic lesion (arrow) that is indistinguishable from a congenital cyst. (d) Photomicrograph (original magnification, x25; H-E stain) shows a portion of tumor wall composed of spindle cells with a relatively compact architecture (arrow) as well as fibrous tissue.

View larger version (124K): [in a new window]   Figure 15b.  Cystic schwannoma in a 17-year-old asymptomatic boy. (a) Chest radiograph shows a well-defined round mass (arrow) in the left part of the superior mediastinum. (b) Contrast-enhanced CT scan shows a thin-walled low-attenuation cystic lesion in the paravertebral region. (c) Axial T2-weighted MR image shows a homogeneous high-signal-intensity cystic lesion (arrow) that is indistinguishable from a congenital cyst. (d) Photomicrograph (original magnification, x25; H-E stain) shows a portion of tumor wall composed of spindle cells with a relatively compact architecture (arrow) as well as fibrous tissue.

View larger version (122K): [in a new window]   Figure 15c.  Cystic schwannoma in a 17-year-old asymptomatic boy. (a) Chest radiograph shows a well-defined round mass (arrow) in the left part of the superior mediastinum. (b) Contrast-enhanced CT scan shows a thin-walled low-attenuation cystic lesion in the paravertebral region. (c) Axial T2-weighted MR image shows a homogeneous high-signal-intensity cystic lesion (arrow) that is indistinguishable from a congenital cyst. (d) Photomicrograph (original magnification, x25; H-E stain) shows a portion of tumor wall composed of spindle cells with a relatively compact architecture (arrow) as well as fibrous tissue.

View larger version (145K): [in a new window]   Figure 15d.  Cystic schwannoma in a 17-year-old asymptomatic boy. (a) Chest radiograph shows a well-defined round mass (arrow) in the left part of the superior mediastinum. (b) Contrast-enhanced CT scan shows a thin-walled low-attenuation cystic lesion in the paravertebral region. (c) Axial T2-weighted MR image shows a homogeneous high-signal-intensity cystic lesion (arrow) that is indistinguishable from a congenital cyst. (d) Photomicrograph (original magnification, x25; H-E stain) shows a portion of tumor wall composed of spindle cells with a relatively compact architecture (arrow) as well as fibrous tissue.

View larger version (115K): [in a new window]   Figure 16a.  Pancreatic pseudocyst in a 45-year-old woman with a 2-week history of dysphagia and chest pain. (a) Contrast-enhanced CT scan shows bilateral pleural effusion and a thin-walled periaortic cystic lesion that displaces the esophagus (arrow) anteriorly. (b) Axial T1-weighted MR image shows a low-signal-intensity cyst (arrow).

View larger version (117K): [in a new window]   Figure 16b.  Pancreatic pseudocyst in a 45-year-old woman with a 2-week history of dysphagia and chest pain. (a) Contrast-enhanced CT scan shows bilateral pleural effusion and a thin-walled periaortic cystic lesion that displaces the esophagus (arrow) anteriorly. (b) Axial T1-weighted MR image shows a low-signal-intensity cyst (arrow).