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A case of jaundice with a mediastinal mass
  1. R Sinha1,
  2. D Clarke2
  1. 1Department of Radiology, Glenfield Hospital, Leicester, UK
  2. 2Department of Radiology, Derby City General Hospital, Derby, UK
  1. Correspondence to:
    Dr R Sinha
    Department of Radiology, Glenfield Hospital, Leicester LE3 9QP, UK;

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Clinical presentation

An elderly male presented with acute upper abdominal pain and tenderness with dyspnoea. On examination he had tachypnoea, tachycardia, hepatomegaly, and tenderness in the right upper quadrant and epigastrium. He also appeared jaundiced and had peripheral oedema of the lower limbs.

Laboratory findings were: aspartate transaminase 118 IU/l (normal range 0–32); alkaline phosphatase 430 IU/l (normal range 60–240); and bilirubin 40 μmol/l (normal range <20).

Chest radiograph performed at presentation suggested a mediastinal mass. Multidetector row computed tomography of the thorax and abdomen was performed for further assessment (fig 1A, B).

Figure 1

 (A) Large lobulated mass involving the pericardium causing luminal compromise of the atria. (B) Coronal reformatted image along the plane of the right atrium and inferior vena cava shows large mass (arrow) with near total obliteration of the right atrial chamber.


What is the diagnosis?

See page 1390 for answer

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