Computerized Tomography and Ultrasonographic Findings in Massive Thymic Hyperplasia

Abstract

Massive thymic hyperplasia in the neonate and young infant can be difficult to diagnose. Differentiation from neoplastic lesions may require thoracotomy for a pathologic specimen. We review a case in a 15-month-old child referred to our institution and discuss the radiographic, ultrasound, and computerized tomographic features of hyperplastic thymic tissue. We review current concepts of the hyperplastic thymus as an anterior mediastinal mass in infancy.

Respiratory distress in a neonate with an enlarged thymus

“…Unfortunately, the test is not speci®c and lymphatic tumours will also involute [6]. An alternative approach is to undertake CT [5], which in our case con®rmed the ®ndings on the chest radiograph. Follow-up is required for all symptomatic children until the thymus involutes, as surgical intervention is necessary in some individuals, particularly when it becomes obvious that the thymic mass is aecting normal pulmonary development [3,4].…”

Laryngo-Tracheal Displacement and Respiratory Distress in an Infant with Congenital Thymic Hyperplasia

“…Performance of a chest X-ray and an ultrasound of the thymus and in some case also MRI or CT scan may be necessary to secure the diagnosis of thymic hyperplasia and to exclude malignancy [1,2]. Especially the ultrasound is an easily accessible diagnostic tool, that shows a typical morphology and is also able to demonstrate correlation with inspiratory stridor with cranial movement of the hypertrophic thymus [1,2].…”

“…If the morphological diagnostic imaging is in favor of this diagnosis of thymic hyperplasia especially in symptomatic infants a trial with corticosteroids, and a close followup as first-line therapy may be considered [1]. Corticosteroids are potent to reduce the volume of the thymus and achieve its partial involution and thereby may prevent invasive surgery in symptomatic patients [3].…”

“…In addition to X-ray, ultrasound, CT, and MRI have been used to confirm the diagnosis in difficult cases [1,2]. Treatment modalities of symptomatic patients are still controversial and corticosteroid therapy for symptomatic thymic hyperplasia has not been proven to be successful so far [3].…”

Watchful waiting for some children with a mediastinal mass: the potential role for 18 F-fluorodeoxyglucose positron emission tomography: a case report and review of the literature

“…BHT spontaneously resolves over time, without specific treatment or surveillance; thus, prognosis and management differ from that of malignant etiologies [1,8]. Fine-needle aspiration cytology and imaging studies (e.g., chest radiograph, ultrasound, and computed tomography [CT]) are used to diagnose BHT in a minimally invasive manner but may result in inadequate biopsy specimens or inconclusive radiologic findings, requiring more invasive and potentially dangerous procedures [9-11]. In one study of 54 children and adults who underwent mediastinal biopsy, the procedure-related morbidity was 6%, and fatalities have been reported [12].…”