Sandbox:Trusha

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[3]

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Cystic mass
Bronchogenic cyst	Abnormal ventral budding or branching of the tracheobronchial tree during embryologic development	Pleuritic chest pain Cough Hemoptysis Fever Pneumonia secondary to airway obstruction	+	-	-			CT scan: Spherical or oval mass Smooth outline Unilocular Noncalcified Demonstrating the size and shape of the cyst Determining its position in relation to other structures Bronchogenic cysts can mimic hydatid cysts Pneumonitis, pneumothorax, or empyema may present
Esophageal duplication cysts	Rare congenital gastrointestinal malformation	Chest pain Stridor Nonproductive cough Epigastric discomfort Vomiting Cardiac arrhythmia Retrosternal and thoracic back pain Cyst ulceration and bleeding Cyst rupture with secondary mediastinitis	-	+	-	Endoscopic ultrasound (EUS) Distinguish between solid and cystic lesions Periesophageal homogeneous-hypoechoic mass Multi-layered wall and well-defined margins Anechoic cyst if considerable central fluid present		Endoscopic ultrasound-guided FNA Atypical in appearance for duplication cysts Malignancy suspicion Endoscopy Indistinguishable from a lipoma, leiomyoma, a gastrointestinal stromal tumor (GIST), or other submucosal lesions
Thymic cyst	Congenital Unilocular Acquired Multilocular associated with: Teratoma Lymphoma Thymic carcinoma Autoimmune disorders	Asymptomatic	-	-	+	Biopsy with histopathology and cytology		CT scan: Oval shape Smooth contour Midline location Calcified Septate cyst Fluid attenuation
Lymphangioma	Turner syndrome Down syndrome Noonan syndrome Chronic lymphatic obstruction such as after surgery, infections or radiotherapy	Constipation Failure to thrive Signs and symptoms of genetic defects	+	+	-	Histopathology and cytology		MRI: Degree of involvement and extent of lesion MRI can prevent extensive, incomplete surgical resection CT scan: Homogeneous, cystic mass Intrinsic septations Compression of adjacent organs
Chronic inflammatory disease
Churg-Strauss syndrome	HLA-DRB1*04 and *07 HLA - DRB4 Allergens Infections Vaccinations (eg, influenza) Drugs: Leukotriene receptor antagonists/ leukotriene modifying agents Anti IgE antibodies (eg, omalizumab) Mesalazine Propylthiouracil Methimazole Exposure to silica Cocaine	Chest tightness Cough Hemoptysis Asthma Weakness Malaise Fever Weight loss Arthralgia Fatigue	+	+/-	-	Lung biopsy 4 out of 6 positive : Asthma Eosinophilia Polyneuropathy or Mononeuropathy Non fixed pulmonary infiltrates Paranasal sinus that is abnormal Eosinophils that are extravascular		High-resolution computerized tomography (HRCT): Airspace consolidations mostly bilateral and lobular Ground-glass opacities in a patchy or subpleural distribution Centrilobular nodules Bronchial wall thickening and/or dilatation Pleural effusions Hilar or mediastinal lymph node enlargement Interlobular septal thickening
Disease	Etiology	Symptoms	Dyspnea/ RI	Dysphagia	SVCS	Gold standard	Image	Additional findings
Posterior mediastinal mass
Cystic mass
Mediastinal neurenteric cyst	Developmental foregut anomaly	Neurologic impairment Back pain Gait disturbance Sensory deficit Motor deficit Stridor Persistent cough	+			CT scan: Cystic nature of the mass Extent of the mass Vertebral anomalies		Postnatal chest X-ray: Posterior mediastinal mass with associated vertebral anomalies Ultrasound: Cystic nature of the mass
Pancreatic pseudocyst	Acute pancreatitis Chronic pancreatitis	Abdominal pain - constant pain or deep ache in the abdomen Pain radiating to the back Abdominal mass Bloating of the abdomen Difficulty eating and digesting food	-	-	-	Histopathology and cytology of cyst and fluid content		CT scan Thin-walled Fluid-containing cyst within the posterior mediastinum In continuity with the intrapancreatic or peripancreatic fluid collections
Central nervous system disease
Meningocele	Congenial defect: Maternal nutrition factors: Alcohol use Caffeine use Low folate intake Elevated glycaemic load or index Low methionine intake Low serum choline level Low serum vitamin B12 level Low vitamin C level Low zinc intake Smoking Hyperthermia Maternal infections and illnesses Pregestational insulin-dependent diabetes Pregestational obesity Psychosocial stress Valproic acid use 2. Environmental factors: Ambient air pollution Disinfectant by-products in drinking water Indoor air pollution Nitrate-related compounds Organic solvents Pesticides Polycyclic aromatic hydrocarbons	Symptoms depend on the severity of the defect Weakness or paralysis in the legs Urinary incontinence Bowel incontinence Sensation problems in the lower extremity Motor problems in the lower extremity Headache Orthopedic abnormalities: Club foot Hip dislocation Scoliosis Difficulties with executive functions including: Planning Organizing Initiating Memory Abstraction Visual planning Attention problems	-	-	-	Prenatal 2D/3D ultrasound: Vertebral defect Splayed vertebral pedicles Disrupted vertebrae Postnatal MRI		Laboratory tests: Elevated Maternal Serum Alpha-Fetoprotein MRI: Herniation of a CSF filled sac through spina bifida CSF attenuation lesion in conus medullaris and other parts of the CNS Short and thick filum terminale
Neurilemmoma (Spinal schwannoma)	Neurofibromatosis type II Schwannomatosis Carney complex	Sharp, aching, or burning pain Pins-and-needles sensation Muscle weakness Numbness Nighttime pain in back or neck	-	-	-	Biopsy with histopathology		MRI Tumor outside of a nerve or part of a nerve and if it involves other nearby structures
ABBREVIATIONS: N/A: Not available, SOB: Shortness of breath, M/C: Most common, RI: Respiratory insufficiency, NM: Neuromuscular system, SVCS: Superior vena cava syndrome, SLE: Systemic lupus erythematosus disease, T3: Triiodothyronine, T4: Thyroxine, TSH: Thyroid stimulating hormone, TFT: Thyroid function test

1. Superior vena cava obstruction
2. Partial anomalous pulmonary venous connection
3. Esophageal achalasia
4. Esophageal cancer
5. Esophageal rupture
6. Hiatus hernia
7. Hilar lymphadenopathy
8. Pneumomediastinum
9. Sarcoidosis
10. Lymphoma
11. Neurilemmoma
12. Non-Hodgkin lymphoma
13. Teratoma
14. Thymoma

1. Thyroid cancer
2. Goitre
3. Mediastinal germ cell tumor,
4. Mediastinal tumor,
5. Mediastinitis

1. Churg-Strauss syndrome
2. Bronchogenic cyst,
3. Dermoid cyst
4. Anthrax:
5. Tularemia

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CT scan showing a smooth anterior mediastinal mass, with a mixed internal density of containing both enhancing soft tissue and cystic areas. The outline of the mass is relatively well defined. No lymphadenopathy, pleural effusion or infiltration. Case courtesy of Dr. Abdallah Al Khateeb (Picture courtesy: Radiopedia)

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CT scan showing excessive fatty tissue deposition within the posterior mediastinum with anterior displacement of the esophagus. Case courtesy of Dr. Ahmed Abdrabou (Picture courtesy: [1])