Do I have to consult a specialist about the mediastinal lesion on the computed tomography (CT) scan?

Hello,

Welcome back to icliniq.com.

I understand your concern. It is quite natural to be worried about mediastinal or thymic lesions, and CT (computed tomography) scan is the best modality for their detection. However, the images (attachment removed to protect the patient's identity) that you have provided are not the proper ones. You have uploaded the "lung window" images specialized for lung lesions. There is another set of images in the "mediastinal window," which shows the lesion properly. Also, those images are in plain and contrast phases, and we need both to make an assessment. Therefore, the best would be if you could upload CD (compact disc), DICOM (digital imaging and communications in medicine), or digital formats of those images, or if you are unable to do so, please provide images of mediastinal window (both plain and contrast).

I hope you understand.

Thank you.

Hi,

Welcome back to icliniq.com.

I have gone through the images (attachment removed to protect the patient's identity) that you have provided, and quite clearly, there is an enlargement of the thymus, having a sort of bulged-out outline than concave. However, if you would upload them, I could have compared these with your previous CT (computed tomography) images. Nonetheless, an enlarged thymus has not taken up much contrast, nor has any calcification, cystic, or necrotic change, or invasion (those are good signs). The concept of thymic rebound is that the naturally shrunken thymus regrows in patients having steroid therapy, chemotherapy, etc. Have you been on any such regimen? It may simply be a rebound and may not require any further action. But if not, then benign thymic neoplasm, that is, the tumor would be the first consideration. In that case, your doctors may suggest you get a biopsy for confirmation, staging, or directly proceed to treatment options, which may involve surgery, radiotherapy, chemotherapy, etc. They may also think of a chest MRI (magnetic resonance imaging), where a thymic rebound would show a chemical shift and a tumor would not. So at this stage, you need to get back to your treating doctors and follow their advice. If you prefer to, you can upload a previous CT to make a comparison with the new scan (not very urgent, though). Lastly, whatever "jagged area" you noticed maybe an artifact or other technical issue unrelated to our physiology or disease. So, ignore it.

I hope you get well soon.

Hi,

Welcome back to icliniq.com.

Thanks for uploading the previous CT (attachment removed to protect the patient’s identity). I can feel your distress since you have to do the research yourself. I suggest you consult the hematologist or oncologist if that is easy for you. Then if they consider it necessary, they may refer you to a thoracic oncologist or thoracic surgeon. I have now seen both CT reports (previous and new). The thymic enlargement is crisp and clear on the new scan, which I described earlier. Without any other scans or history of chemotherapy and steroids, I would consider it a thymoma first. But on the previous scan, the lesion is not as prominent as to be identified outright and can be seen only in retrospect. That means there has been a sudden enlargement of the thymus, which considers a thymic rebound. That creates a dilemma since you do not have a history to explain rebound. One way to sort out the confusion may be MRI with chemical shift sequences, but the most definitive way is to do a biopsy. In this context, I would suggest you get in touch with the concerned specialists (oncologists or thoracic specialists) so that they can make a complete evaluation of your history, clinical condition, and previous medical records to make a precise diagnosis. I understand that it is stressful and confusing for you. Still, it will become effortless and easy once you attend the appropriate specialists since they have adequate experience directly dealing with mediastinal lesions. I do not think you need to consult an ENT (ear, nose, and throat) specialist for the thymus; maybe your doctor mentioned this for another purpose.

The Ambra viewer in our software does not offer measurement tools, but it provides a scale from which the lesion is around 2 x 2 x 4 cm. So, to sum up, I suggest you consult an oncologist or thoracic surgeon and follow their advice further.

Kindly revert in case of further queries.