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Congress: ECR26
Poster Number: C-10853
Type: Poster: EPOS Radiologist (educational)
Authorblock: J. H. B. P. Furlan, E. K. U. N. Fonseca, M. V. Y. Sawamura, P. Gaspar dos Santos, J. M. Cortez Filho, M. Tonholo Ikedo, P. Esrom, F. D. C. Bernardi, A. S. Silva Mesquita; São Paulo/BR
Disclosures:
João Henrique Barros Penteado Furlan: Nothing to disclose
Eduardo Kaiser Ururahy Nunes Fonseca: Nothing to disclose
Marcio Valente Yamada Sawamura: Nothing to disclose
Pedro Gaspar dos Santos: Nothing to disclose
João Martins Cortez Filho: Nothing to disclose
Matheus Tonholo Ikedo: Nothing to disclose
Paulo Esrom: Nothing to disclose
Fabiola Del Carlo Bernardi: Nothing to disclose
Ana Sofia Silva Mesquita: Nothing to disclose
Keywords: Mediastinum, CT, Digital radiography, MR, Diagnostic procedure, Cancer, Cysts, Pathology
Learning objectives While the prevascular compartment is often recalled through the “4T’s” differential (thymoma, teratoma, thyroid, lymphoma), the visceral and paravertebral compartments harbor a broader spectrum of entities. This exhibit aims to review updated mediastinal anatomy and compartmental classification, highlight key imaging features and epidemiology of visceral and paravertebral lesions through illustrative cases, and propose a structured approach to differential diagnosis in these compartments [1,2].
Read more Background To address localization inconsistencies, the International Thymic Malignancy Interest Group (ITMIG) established a standard CT-based classification (2017), dividing the mediastinum into three distinct compartments [1]. This anatomical division provides a systematic framework for differential diagnosis based on the specific contents of each zone: Prevascular Compartment: Definition: From the posterior border of the sternum to the anterior aspect of the pericardium. Contents: Thymus, fat, lymph nodes, and the left brachiocephalic vein. Visceral Compartment: Definition: Extending from the posterior boundary of the prevascular zone to a vertical...
Read more Findings and procedure details 1. DIAGNOSTIC ALGORITHM: Accurate localization is required using two radiological principles: The Center Method: The geometric center of the lesion typically corresponds to the compartment of origin. The Displacement Principle: Expansile lesions displace adjacent structures away from their site of origin. Identifying which organs are displaced helps determine where the lesion did not arise. [fig 2] 2. DIAGNOSTIC FRAMEWORK: A SYSTEMATIC APPROACHWe propose a four-step evaluation method applied before pattern recognition: CLINICAL CONTEXT Age Symptoms: Incidental vs. Compressive vs. Functional syndromes. MORPHOLOGICAL CHARACTERIZATION Laterality: Unifocal vs. Bilateral/Multifocal. Internal Matrix: Fluid, Fat,...
Read more Conclusion A thorough understanding of mediastinal compartments is fundamental for accurate imaging interpretation. Applying a structured approach that integrates anatomy, lesion characteristics, and associated findings improves diagnostic precision beyond the prevascular zone.
Read more References CARTER BW, TOMIYAMA N, BHORA FY, DE CHAISEMARTIN L, GHIGNA MR, MAROM EM, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2017 Jan;12(1):171–86. CARTER BW, BENVENISTE MF, MADAN R, GODOY MC, DE GROOT PM, TRUONG MT, et al. ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses. Radiographics. 2017 Mar-Apr;37(2):413–36. YOON Y, LEE K, KIM T, KIM J, SHIM Y, HAN J. Intrapulmonary Bronchogenic Cyst: CT and Pathologic Findings in Five Adult Patients. AJR Am J Roentgenol....
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