This 19 year-old female patient presented with general malaise. A chest x-ray demonstrates lobulated mediastinal widening, most marked in a right paratracheal location, but also present in the azygous node and aortopulmonary window locations.

Hodgkin’s disease is a form of lymphoma characterized by the presence of Reed-Sternberg cells. There is a bimodal age distribution with peaks in the 20s and 70s. The nodular sclerosing type is most common. Involvement of the thorax occurs in the majority of cases, and superior mediastinal lymphadenopathy is present in nearly all cases with thoracic involvement. Multiple nodal groups are typically involved. Lung involvement occurs in 10% at diagnosis, rarely in isolation.

After treatment residual soft-tissue mediastinal masses are common, as are calcified lymph nodes. Gallium scans or positron emission tomography can be helpful in distinguishing active tumour from residual mass.

Reference: Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins 2005

Credit: Dr Laughlin Dawes