by Dr Noreen Norfaraheen Lee Abdullah MD (UKM), MMed Radiology (UKM), AM(Mal)

Answer to Case Of the Month 
Thoracic Teratoma

Discussion of Findings
Chest radiograph: A homogenous opacity in the left hemithorax causing obliteration of left heart border and left hemidiaphragm. There was mass effect as evidenced by mediastinum shift and tracheal deviation to the right. The cardiac silhouette was displaced by the mass. Abrupt truncation of the left main bronchus noted. No rib erosion. The features were consistent with a large left hemithorax soft tissue mass. Massive pleural effusion is a differential.

CT Thorax: A large inhomogenous mass of mixed density was seen to occupy the left hemithorax. There were multiseptated cystic, solid and soft tissue components seen within this mass. Speckles of calcification were noted within the mass in the precontrast scan. Post IV contrast media there was moderate enhancement. The mass showed mass effect as evidenced by the displacement of the mediastinal structures to the contralateral side. It abutted the heart, left pulmonary artery and the arch of aorta. The left lung was not aerated and was compressed by the mass. The right lung is aerated and small in capacity. An enhancing lung nodule with adjacent consolidation was seen in the right lower lobe. This would be in keeping with lung metastasis. There were no mediastinal lymph nodes. The conclusion was a large hemithorax mass, most likely a teratoma with right lung metastasis.

A fine needle biopsy of the left lung was done and the report was most likely teratoma - immature type.

The child passed away.

Intrapulmonary teratomas are rare and believed to originate from the third pharyngeal pouch. There is slight female preponderance. They are usually diagnosed in the third or fourth decade of life. Mature teratomas are benign lesions. The typical clinical features are chest pain (52%) hemoptysis (42%) and cough (39%). The most specific symptom is trichoptysis or expectoration of hair. Radiologically, they present as lobulated lung masses, which showed areas of calcification. Fat density is seen in 50% cases. Fat fluid levels have also been reported. Soft tissue elements may also be present. Two thirds of the cases occur in the upper lobes - usually in the left upper lobe. Benign mature teratomas have a predominant cystic component. Solid components predominate in immature or malignant teratomas. Cysts often contain hair and calcification. Continuity with a bronchus may be seen in 42% cases. Bronchiectasis occur in 16% cases and may delay recognition of the pulmonary tumor.

Please click here for more cases!
 

Copyright © 2001-2010 College of Radiology, Academy of Medicine of Malaysia
All Rights Reserved

Terms of Use

Last Updated:
Tuesday, 04 January 2005