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==Overview==
==Overview==
Computed Tomography is the radiologic modality of choice to diagnose and evaluate thymoma. The tumor is generally located inside the thymus, and can be calcified. Increased vascular enhancement can be indicative of malignancy, as can be [[pleural deposits]].
* [[Computed Tomography]] scan may be diagnostic of thymoma.
* The tumor is generally located inside the thymus, and can be calcified.  
* Increased vascular enhancement can be indicative of malignancy, as can pleural deposits.


==CT Scan==
==CT Scan==
When a thymic mass is identified, the made is achieved with [[histology]] (obtaining a tissue sample of the mass). When a thymoma is suspected, a [[Computed axial tomography|CT/CAT scan]] is generally performed to estimate the size of the tumor, and can be [[biopsy|biopsied]] with a CT-guided needle. There is a small risk of [[pneumomediastinum]], [[mediastinitis]] and the risk of damaging the [[heart]] or large blood vessels. The final diagnosis is made by removing the thymus. [[Anatomical pathology|Pathological]] investigation of the specimen will reveal if the tumor was benign or malignant, although the initial biopsy is usually indicative.<ref name="pmid10561285">{{cite journal |author=Thomas CR, Wright CD, Loehrer PJ |title=Thymoma: state of the art |journal=[[Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology]] |volume=17 |issue=7 |pages=2280–9 |year=1999 |month=July |pmid=10561285 |doi= |url=http://www.jco.org/cgi/pmidlookup?view=long&pmid=10561285 |accessdate=2012-01-18}}</ref>
When a thymoma is suspected, a [[Computed axial tomography|CT/CAT scan]] is generally performed to estimate the size of the tumor.
 
Key CT scan findings in thymoma include:
===Criteria of CT===
*Smooth or lobulated border that is partially or completely outlined by [[fat]]
*Smooth or lobulated border that is partially or completely outlined by fat.
*Homogeneous soft tissue mass
*Homogeneous soft tissue mass.
*[[Fibrosis]], [[cysts]], [[hemorrhage]] or [[necrosis]] may be seen as decreased attenuation
*Fibrosis, cysts, hemorrhage or necrosis may be seen as decreased attenuation.
*[[Amorphous]], flocculent central/curvilinear peripheral [[calcification]]
*Amorphous, flocculent central/curvilinear peripheral calcification.
 
==Biopsy==
'''[[CT-guided core needle biopsy]]''' or '''[[CT-guided fine needle-aspiration]]''' (FNA) should be done to confirm the histological classification and the diagnosis. CT-guided FNA has higher sensitivity and specificity and also less side effects than the core needle biopsy, but it has lower chances of differentiating between thymoma and thymic carcinoma which is important for the appropriate management plan.
If both modalities failed to obtain the accurate diagnosis, [[mediastinoscopy]], [[videothoracoscopy]] (VATS) or a diagnostic and therapeutic [[en bloc thymectomy]] might be considered.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Percutaneous needle biopsy of the mediastinum: review of 94 procedures. | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC464591/ | publisher =  | date =  | accessdate = }}</ref><ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Anterior mediastinal masses: utility of transthora... [Radiology. 1991] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/1647039 | publisher =  | date =  | accessdate = }}</ref>


{|
{|
| [[File:T001.png|x300px|thumb|CT scan of the chest revealing a large necrotic mass in the left anterior mediastinum (later proven to be a thymoma) and bilateral hilar lymphadenopathy.]]
| [[File:T001.png|x200px|thumb|CT scan of the chest revealing a large necrotic mass in the left anterior mediastinum (later proven to be a thymoma) and bilateral hilar lymphadenopathy.]]
| [[File:T002.png|x300px|thumb|CT shows [[Thymoma]] (Thymoma, Stage IIA. CT scan, axial).]]
| [[File:T002.png|x200px|thumb|CT shows [[Thymoma]] (Thymoma, Stage IIA. CT scan, axial).]]
| [[File:Thymoma-001.jpg|x200px|thumb|CT shows [[Thymoma]] <small>(Image courtesy of RadsWiki and copylefted).]]
|}
|}
{|
{|
| [[File:Thymoma-001.jpg|x300px|thumb|CT shows [[Thymoma]] <small>(Image courtesy of RadsWiki and copylefted).]]
| [[File:Th00.png|x200px|thumb|A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, axial.<ref name="radio">Image courtesy of  Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/articles/thymic-epithelial-tumours].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
| [[File:Th00.png|x300px|thumb|A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, axial.]]
| [[File:Th01.png|x200px|thumb|A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, coronal.<ref name="radio">Image courtesy of  Dr Hani Al Salam. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/articles/thymic-epithelial-tumours].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
| [[File:Th04.png|x150px|thumb|CT shows Invasive Thymoma.]]
| [[File:Th06.png|x200px|thumb|CT shows anterior mediastinal mass, pathologically shown to be a thymoma.]]
|}
|}
{|
{|
| [[File:Th01.png|x300px|thumb|A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, coronal.]]
 
| [[File:Th04.png|x300px|thumb|CT shows [[Invasive Thymoma]].]]
| [[File:Th07.png|x200px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.<ref name="radio1">Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/cases/thymoma-8].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
|}
| [[File:Th08.png|x200px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.<ref name="radio1">Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/cases/thymoma-8].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
{|
| [[File:Th09.png|x200px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.<ref name="radio1">Image courtesy of  Dr Frank Gaillard. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/cases/thymoma-8].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
| [[File:Th05.png|x300px|thumb|CT shows [[Invasive Thymoma]].]]
| [[File:Th11.png|x200px|thumb|CT showing well defined solid lesion is seen in the anterior mediastinum. No calcification cystic or fat component is seen within.<ref name="radio12">Image courtesy of    Dr Prashant Mudgal. [http://www.radiopaedia.org Radiopaedia] [http://radiopaedia.org/cases/thymoma-11].[http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
| [[File:Th06.png|x300px|thumb|CT shows anterior mediastinal mass, pathologically shown to be a thymoma.]]
|}
{|
| [[File:Th07.png|x300px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.]]
| [[File:Th08.png|x300px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.]]
|}
{|
| [[File:Th09.png|x300px|thumb|CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.]]
| [[File:Th11.png|x300px|thumb|CT showing well defined solid lesion is seen in the anterior mediastinum. No calcification cystic or fat component is seen within.]]
|}
{|
| [[File:Th12.png|x300px|CT showing well defined solid lesion is seen in the anterior mediastinum. No calcification cystic or fat component is seen within.]]
|}
|}


==References==
==References==
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{{Reflist|2}}
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Latest revision as of 19:08, 14 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief: Amr Marawan, M.D. [5]Ahmad Al Maradni, M.D. [6]

Overview

  • Computed Tomography scan may be diagnostic of thymoma.
  • The tumor is generally located inside the thymus, and can be calcified.
  • Increased vascular enhancement can be indicative of malignancy, as can pleural deposits.

CT Scan

When a thymoma is suspected, a CT/CAT scan is generally performed to estimate the size of the tumor. Key CT scan findings in thymoma include:

CT scan of the chest revealing a large necrotic mass in the left anterior mediastinum (later proven to be a thymoma) and bilateral hilar lymphadenopathy.
CT shows Thymoma (Thymoma, Stage IIA. CT scan, axial).
CT shows Thymoma (Image courtesy of RadsWiki and copylefted).
A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, axial.[1]
A 43-year-old female with myasthenia gravis. Chest CT demonstrate a small soft tissue mass at the anterior mediastinum, pathologically proven thymoma, coronal.[1]
CT shows Invasive Thymoma.
CT shows anterior mediastinal mass, pathologically shown to be a thymoma.
CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.[2]
CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.[2]
CT demonstrates a well circumscribed soft tissue mass in the anterior mediastinum, proven to be thymoma.[2]
CT showing well defined solid lesion is seen in the anterior mediastinum. No calcification cystic or fat component is seen within.[3]

References

  1. ↑ 1.0 1.1 Image courtesy of Dr Hani Al Salam. Radiopaedia [1].Creative Commons BY-SA-NC
  2. ↑ 2.0 2.1 2.2 Image courtesy of Dr Frank Gaillard. Radiopaedia [2].Creative Commons BY-SA-NC
  3. ↑ Image courtesy of Dr Prashant Mudgal. Radiopaedia [3].Creative Commons BY-SA-NC

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