Clinical Presentation
A 58-year-old man with progressive dyspnea, cough, and dysphagia.
Imaging Findings
(A) Contrast-enhanced computed tomography (CT) shows a large mediastinal mass (white arrow) with heterogeneous enhancement, airway compression (black arrows), and bilateral pleural fluid collections. (B) Lung window image shows interlobular septal thickening and ground-glass opacity in the right lung.
Differential Diagnosis
• Small-cell lung cancer (SCLC): The most common imaging presentation is a large mediastinal mass, generally without imaging evidence of a lung parenchymal lesion.
• Lymphoma: A large mediastinal mass may also be the initial presentation of a lymphoma. The presence of airway obstruction helps in the differentiation between lymphoma and SCLC. Bronchial narrowing or an intraluminal mass is more common in lung cancer than in lymphoma.
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