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Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 37-Year-Old Woman With an Incidentally Found Mediastinal Nodule*

Gijs Limonard, MD; Joris Joosten, MD; Yvonne Berk, MD; Ineke De Kievit, MD, PhD; Saskia Zomer, MD; Mariël Keemers, MD, PhD
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*From the Departments of Pulmonary Diseases (Drs. Limonard and Berk), General Surgery (Drs. Joosten and Keemers), and Pathology (Drs. De Kievit and Zomer), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.

Correspondence to: Gijs Limonard, MD, Department of Pulmonary Diseases, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6525 SZ Nijmegen, the Netherlands; e-mail: g.limonard@cwz.nl



Chest. 2008;133(6):1508-1511. doi:10.1378/chest.07-2513
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A 37-year-old woman presented with a sudden onset of right-sided chest pain and dyspnea the day after she underwent an abdominal hysterectomy for excessive menstrual bleeding. The pain was constant and worsened with breathing. Medical history was significant for a splenectomy following a motor vehicle accident at the age of 9 years. She had a 20–pack-year history of smoking. A pulmonary embolism was suspected. Multidetector-row spiral CT of the chest showed compression atelectasis of the basal segments of the right and left lower lobes but no pulmonary embolism. Unexpectedly, a well-circumscribed, homogeneously enhanced mediastinal nodule 15 mm in diameter was seen in the anterior superior mediastinum (Fig 1 , left, A). With analgetic treatment, she was discharged free of symptoms on the seventh postoperative day. At the following visit to the Department of Pulmonary Diseases, she denied any complaints. Physical examination and laboratory findings were unremarkable. In addition to the known mediastinal nodule (Fig 1, left, A), conventional contrast-enhanced chest CT revealed the presence of a pleural nodule 5 mm in diameter located anterolaterally in the left hemithorax (Fig 1, right. B). The patient underwent video-assisted thoracoscopic surgery. The mediastinal nodule seen on CT correlated with a reddish pedunculated nodule closely adherent to the left superior mediastinum (Fig 2 , left, A). Several other, smaller pleural-based lesions with a similar appearance were noted (Fig 2, right, B). The mediastinal nodule was resected and sent for pathologic examination (Fig 3 ). The other lesions were left intact.

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