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Pleural Effusion Overview
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Transient mediastinal mass from fluid overload.

David Massicotte-Azarniouch1, Joseph P O'Sullivan2, Edward G Clark3

  • 1Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.

Hemodialysis International. International Symposium on Home Hemodialysis
|June 29, 2016
PubMed
Summary
This summary is machine-generated.

Mediastinal edema can mimic a mass on chest imaging, especially in patients with fluid overload. Correcting fluid overload and repeating imaging can avoid unnecessary invasive procedures for suspected malignancy.

Keywords:
Mediastinal masschest computed tomographyhemodialysispulmonary edema

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Area of Science:

  • Radiology
  • Cardiology
  • Nephrology

Background:

  • Mediastinal masses on chest imaging often raise concerns for malignancy, such as lymphoma or metastatic cancer.
  • Acute fluid overload can present radiographically mimicking a mediastinal mass, particularly mediastinal edema.

Observation:

  • A 75-year-old woman with end-stage renal disease and acute pulmonary edema secondary to Non-ST-Elevation Myocardial Infarction presented with a 4.2 × 2.5cm middle mediastinum soft-tissue mass on CT.
  • Initial suspicion for malignancy was tempered by the clinical context of severe fluid overload and lack of other malignant signs.

Findings:

  • The patient's fluid overload was managed by adjusting hemodialysis dry weight.
  • A repeat chest CT after 8 weeks of euvolemic management showed complete resolution of the mediastinal mass.

Implications:

  • Mediastinal edema is a potential mimic of mediastinal masses in patients with fluid overload.
  • Considering fluid overload and repeating imaging in appropriate clinical contexts can prevent unnecessary invasive diagnostic procedures and associated risks.