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A 51-year-old male presented to our tertiary referral hospital with progressive shortness of breath and orthopnea. A computed tomography (CT) of the chest was performed that showed a large cystic middle mediastinal mass. Magnetic resonance imaging (MRI) of the chest demonstrated a large, well-circumscribed, T2-hyperintense cystic middle mediastinal mass resulting in significant compression of the trachea, brachiocephalic artery, superior vena cava, and azygos vein. The patient subsequently developed a right hemispheric stroke due to compression of the brachiocephalic artery and was too clinically unstable to undergo or definitive operative management of the mediastinal cyst. Percutaneous CT-guided aspiration of the cystic middle mediastinal mass was performed, with successful decompression resulting transient improvement in mass-effect on the surrounding mediastinal structures. Six days after successful aspiration of the mass, the patient underwent attempted bronchoscopy for management of tracheobronchial secretions which was complicated by massive pulmonary hemorrhage leading to cardiopulmonary arrest and death. An autospy was conducted, revealing pathological finding consistent with a mature cystic teratoma., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to assess the potential role for chemical shift magnetic resonance imaging (MRI) in identifying lymphangiomas from other cystic mesenteric and retroperitoneal masses., Materials and Methods: A retrospective search of radiology database identified 24 consecutive patients with mesenteric and retroperitoneal cysts (nine men, 15 women; mean age, 41 years; age range, 19-75 years) who had undergone MR which included in-phase and opposed-phase chemical shift imaging. Signal intensity (SI) decrease between in-phase and opposed-phase MR images of the cyst was evaluated qualitatively by two radiologists. Ultrasound (US), computed tomography (CT), and MRI findings of the morphological appearances of all the cystic lesions that demonstrated significant signal drop on chemical shift MR were also recorded., Results: Of mesenteric and retroperitoneal cysts, 33% (8/24) revealed qualitative decrease in intensity on opposed-phase MR images relative to that seen on in-phase images. On ultrasound, these cysts demonstrated anechoic simple fluid. Their mean CT attenuation was 13 HU (range: 5-20 HU). Signal loss on fat-suppressed T1-weighted sequences was displayed only by a single cyst. None of the lesions with qualitative SI decrease on opposed-phase MR showed suggestion of lipid on US and CT., Conclusion: The presence of intra cystic lipid detected by chemical shift MR may not be overt on cross-sectional imaging such as US and CT. Chemical shift MRI provides additional sensitivity and specificity as an imaging test for demonstration of lipid within mesenteric and retroperitoneal cysts enabling a higher diagnostic yield for lymphangioma leading to more appropriate patient management., (Copyright © 2011 Elsevier Inc. All rights reserved.)