on December 12, 1979.
68
monary ​Medicine, Tufts University School of
CT Diagnosis of Benign
Mediastinal Abnormalities
Robert ​D. ​Pugatch1
L. Jack Faling2 ​Alan H.
Robbins1
Richard Spira1
Thoracic CT scanning was performed in 49 adult male patients
suspected mediastinal mass. A correct diagnosis would have been made in only 20 instances
of conventional chest radiography. Specific diagnoses estab- l​ ished ​by CT included 14 cases of
se mediastinal fat deposition, five mediastinal cysts, and six anomalies or aneurysms of the
Four miscel- laneous lesions were also clarified. Thoracic angiography would undoubtedly
ed vascular abnormalities, but was obviated in most instances. CT accurately ​defined anatomic
and distinguished vascular from nonvascular masses in the ​16 patients who underwent
oracotomy or mediastinoscopy. When CT ​demonstrated a fatty or cystic lesion, no attempt at
mation was undertaken ​in all but ​two of the asymptomatic patients. Clinical follow-up from 6
years in conjunction with select correlative radiologic procedures have supported the CT
e ​nonoperated group. CT should be the initial procedure for evaluating most patients with
abnormalities detected by plain chest radiography. If the patient is asymptomatic and the
provided by CT indicates a benign process, conservative management with careful follow-up
Received November 3, 1978; accepted after
Subjects and Methods
Between September 1976 and March 1979, 49 patients at the Boston Veterans Admin- ​istration Medical Center were examined for mediastinal abnormalities which
Department of Radiology, Tufts University 5
ol ofMedicine, Boston. and Boston Veterans
inistration Medical Center, 150 S. Huntington ​Ave.,
n, MA 02130. Address reprint re- quests to A. D. Pugatch.
2 ​Pulmonary Disease Section, Boston
r- sity ​School of Medicine; Department of
cine, Boston; and Boston Veterans Administration
ical Center, Boston, MA 02130. ​AJR 1​ 34:685-694, ​April
​0361 -803X/80/1 344-0685 $00.00
The evaluation of mediastinal abnormalities is a challenging radiographic problem. Many are firs
patients who have no abnormal physical findings.
many of these individuals have undergone mediast
Cross- sectional imaging of the mediastinum by co
anatomic detail. We have analyzed the contributio
group of adult male patients.
or clearly detected on posteroanterior and lateral chest radiographs. Excluded were
c carcinoma, lymphoma, or primary extrathoracic malig- nancies who were undergoing
disease. Patients with ​abnormalities of the pulmonary hila were also excluded.
For 23 patients, CT was performed with an Ohio Nuclear Delta 50
, an Ohio Nuclear 201 0 (2 sec) scanner was used. All examinations were
addition, prone scans were obtained in a few select ​cases. Breath-holding i​ n full
canner, but was not ​possible with the 2​ ’/2 m​ m scanner. Intravenous contrast infusion
e 30% (Reno-M-DIP, Squibb) or a 50-100 ml intravenous bolus of meglumine ​diatrizoate
afin 60, Squibb) was used when a vascular abnormality was suspected.
inal abnormalities were ob- tained before and after intravenous contrast
ddition to ​posteroanterior and lateral chest radiographs obtained in all cases at the time of
 were suspected
686 ​PUGATCH ET AL. AJR:134, ​April 1980

Fig. 1 -vascular vs. nonvascular mediastinal mass in asymptomatic 70-year-old patient. Posteroanterior ​(A) ​and lateral (B) chest films. ​Right superior mediastinal mass ​(arrows)
and probable aneurysm of descending aorta. Oblique radiography, fluoroscopy, and anteropos- tenor tomography failed to clarify whether retrotracheal superior
mediastinal mass was of vascular origin. C ​ , Contrast-enhanced scan after ​intravenous infusion of 300 ​ml of Reno-M-DIP. On serial scans, mass was shown to represent
aneurysm of aberrant right subclavian artery. T ​ his scan taken at its point of origin shows posterior tracheal ​(T) indentation and displacement of right mediastinal pleura laterally
(arrows). D ​ , Cursor shows enhancing true lumen of aneurysm of descending aorta. Low density area believed to represent associated thrombosis ​(TH).

Of the 49 patients, ​39 were judged to have benign me- diastinal

processes when CT findings were correlated with ​final ​pathologic
examination, conventional anteroposterior tomograms of the me- ​diastinum were specimens obtained at thoracotomy in six ​patients, or with clinical,
available for comparison in 12 patients, angiograms in four, and ultrasonograms in one.
laboratory, and radiographic (in-
cluding angiographic and ultrasonic) features in the other ​33 patients. Clinical
and radiologic follow-up in this latter group is from 6 ​months to 3 years.
The remaining 10 patients had thoracic malignancies confirmed at thoracot- ​omy
Result
or mediastinoscopy.
s
 abnormality of the superior medias- ​tinum at or above the level of the great
vessels. When
Superior Mediastinum

Of the 49 patients examined, 24 had plain chest radio- graphs that showed an
AJR:134, April 1980 ​CT OF BENIGN MEDIASTINAL ABNORMALITIES 687

#{188}

Fig. 2.-Diffuse mediastinal fat deposition in 58-year-old asymptomatic ​patient. Posteroanterior (A) and
lateral (B) films. Superior mediastinal widen- ​ing and suspected anterior mediastinal mass suggested
by superior medias- tinal fullness, probable paratracheal widening, and abnormal retrosternal ​density. C.
Superior vena cava (C) and transverse part of aortic arch (A) surrounded by excessive
homogeneous anterior mediastinal fat. Focal fat ​deposition also widens rightparatracheal region
(arrows). ​Mediastinal lipom- ​atosis due to obesity, exogenous steroids, or as normal variant is
easily confirmed by CT, and excludes other diagnostic considerations.

Five patients were thought to have a nonvascular medias- tinal mass

radiographic and clinical information was reviewed prior to CT, the correct
nature of the mediastinal abnormality was ​strongly suspected in 13 patients
and remained unclear in ​1 1 others.
Five patients had chest radiographs and clinical findings ​that
suggested a vascular etiology for their superior medias- tinal mass. CT
demonstrated abnormalities of the ascending ​aorta or great vessels in all five
(fig. 1​). ​Thoracic aortogra- phy, performed in two patients when elective
aneurysmec- ​tomy was planned, confirmed the CT findings. The CT ​diagnosis
was considered conclusive and angiography un- necessary in the three
other cases.
on the basis of information prior to CT. Three had ​a previously diagnosed
extrathoracic malignancy and meta- ​static lymphadenopathy was strongly
considered. Conven- tional mediastinal tomography failed to clarify
whether the ​mass detected on the chest radiograph was of vascular or
nonvascular origin in ​these three patients. The CT findings
in all five patients clearly demonstrated a vascular origin of the abnormality
obviating further investigation. Stable clini- cal and radiologic follow-up of these
patients for ​at least 12 ​months supports the CT findings.
Two asymptomatic patients had localized left superior mediastinal
widening on their chest radiographs and lymph- adenopathy was initially
suspected. CT scanning demon- ​strated focal mediastinal fat deposition in
both, and further ​evaluation was considered unnecessary.
Three patients had superior mediastinal widening on their
posteroanterior chestfilm with obliteration ofthe retrosternal ​clear space on
the lateral projection. In two patients, me- diastinal lymphadenopathy or a
primary mediastinal mass was the primary diagnosis prior to CT scanning;
however, CT demonstrated only homogeneous fat deposition (Fig. 2). CT
688 ​PUGATCH ET AL. ​AJR:134, April 1980
fr.
-,
A
seven of nine patients with a right ​paratracheal mass. The ​thoracic surgical
service requested CT prior to surgery to exclude a vascular abnormality.
(However, ​we doubt that ​thoracic aortography would have been performed in the
absence of CT capability.) CT showed nonvascular masses in all seven instances.
In the other two patients, a vascular abnormality was predicted, but CT
demonstrated a nonvas- cular mass, thereby obviating angiography. Eight of these
nine patients had metastatic mediastinal lymphadenopathy diagnosed at
mediastinoscopy and/or thoracotomy. The exception was an asymptomatic
30-year-old man whose right paratracheal mass was shown by CT to be enlarged,
densely calcified, azygos lymph node. The patient was subsequently diagnosed to
have inactive histoplasmosis. A low kilovoltage chest film, fluoroscopy, or
conventional to- mography would probably have identified the calcifications
equally well, however.
In summary, the cause of an abnormal superior medias- tinum on chest
radiography was correctly diagnosed prior to CT in only 13 of the 24 patients. CT
provided specific diagnostic information not otherwise available in 1 1 of these 24
cases, and, in many, obviated thoracic angiography and probable mediastinoscopy
or diagnostic thoracotomy. CT was also of value in planning surgical procedures
in the eight patients who underwent operation.
Anterior Mediastinum
Eleven patients were examined by CT for anterior me- diastinal
abnormalities. In six, masses were contiguous to the ​right ​or left heart border
demonstrated mediastinal lipomatosis in the third patient who had been ​receiving
steroid therapy for a malignant ​lymphoma.
A nonvascular abnormality was strongly suspected in
within the anterior cardiophrenic ​angle. While a​ diagnosis of pericardial cyst or fat
pad was
​ T was performed to differentiate c​ yst from fat pad
likely in these six patients, C
and to exclude unusual juxtacardiac le- sions. CT findings were consistent with a
pericardial cyst or diverticulum in four patients; attenuation numbers r​ anged ​from
-5 to +25 Hounsfield units (H). Prone scanning ​showed dramatic change in the
size and configuration of these abnormalities when compared with supine
views, es- tablishing their cystic nature. Thoracotomy confirmed a large
pericardial cyst in one patient. (Two of these cases ​have been published
previously [4].) The remaining three patients have been clinically and
radiographically stable for ​6 months to 3 years (fig. 3). CT showed the two
other ​cardiophrenic angle lesions ​to be large epicardial fat pads. ​This was
confirmed in one patient when exploratory thora- cotomy was performed for
excision of an unrelated right lower lobe hamartoma.
The nature of the anterior mediastinal mass was unclear ​in four of the
remaining five patients; three were asympto- matic and two ​complained of chest
pain. In the three asymp- ​tomatic patients, CT demonstrated focal anterior
mediastinal fat deposition obviating further evaluation for suspected thymoma.
This group included a slowly growing anterior mediastinal mass, which on review
of old films had been ​present for at least 4 years and probably represented a
lipoma or thymolipoma. Conventional mediastinal tomogra- ​phy in the two
symptomatic patients strongly suggested a ​thymic lesion in one. The etiology
of the anterior mediastinal mass was unclear in the other. CT clarified the relations
of these two masses to neighboring vascular structures. CT- guided aspiration
biopsy of the first lesion, which was inti- mate to the right ventricular outflow
tract, disclosed thy- ​moma subsequently confirmed at thoracotomy. In the
sec- ​ond case, distortion and invasion of mediastinal and pen-
AJA:134, April 1980 ​CT OF BENIGN MEDIASTINAL ABNORMALITIES ​689

Fig. 4.-Malignant thymoma in 52-year-old man with chest pain. A and B, Bilateral mediastinal widening and increased retrosternal density. Elevation of left diaphragm with basilar atelectasis, but
no diaphragmatic paralysis. C, Nonenhanced scan below carina. Mass widens anterior mediastinum bilaterally ​(arrows). ​D, ​After intravenous injection of 50 ml Aenografin 60. Mass
encompasses ascendIng aorta (AA). Residual contrast in intrapericardial part of right pulmonary artery ​(arrows). L​ ow density filling defect ​(arrowhead) i​ n superior vena cava (C) compatible
​ y mass. DA ​= ​descending aorta.
with intracaval tumor or thrombosis. T appearance indicates that major intrapericardial structures are Involved b
patient. An asympto- matic 26-year-old man had a round, sharply defined, middle
mediastinal mass in close proximity to the left pulmonary ​artery on a​
screening chest film. Initial investigation with CT
cardial fat planes prompted a limited thoracotomy for tissue ​confirmation
excluded an abnormal pulmonary artery or an aortic lesion, obviating
of a malignant thymoma (fig. 4). angiography. The attenuation of the mass was 0- 20 H and, as predicted by both
conventional radiography and CT, a bronchogenic cyst was excised at
thoracotomy. ​A 30-year-old patient with dysphagia and a large subcarinal
mass on barium swallow also had right hiiar, anterior me- diastinal, and right
Middle Mediastinum paratracheal lymphadenopathy demon- strated on CT. Anteroposterior and lateral
mediastinal to- mography demonstrated only the right hilar disease. Me-
Three masses occupying the middle mediastinum were encountered. The diastinoscopy rather than thoracotomy was performed on the basis of ​CT
correct diagnosis based on the plain film findings was suspected in only one
findings and tuberculous mediastinitis was diagnosed. A large middle mediastinal
 mass in a 73-year-
690 PUGATCH ET AL. AJR:134, ​April 1980
intimate to the left heart border, believed to be thymic or ​penicardial. The cystic nature of the mass was subsequently ​confirmed by ultrasound and no
treatment ​or further workup was pursue#{231}l.
Posterior Mediastinum
Eleven patients with masses in the posterior mediastinum were evaluated. The correct diagnosis was made in only three of these ​patients prior to CT.
Six cases of right paraspinal widening were examined. In two, CT was performed to further define the paraspinal ​component of probable osteomyelitis.
CT-guided aspiration ​biopsy identified ​Staphylococcal aureus a​ s the causative organism in both cases. Another patient with right panaspinal widening
was shown on CT to have azygos continuation of the inferior vena cava, subsequently confirmed by an inferior ​venacavogram (fig. 5). Three patients
with a localized right
D ​paraspinal mass had right paraspinal fat deposition dem- onstrated by CT after plain films, barium swallow, and iso- ​topic bone scanning failed to
establish a diagnosis.
Three patients were shown to have unusual diaphragmatic ​hernias, and a fourth was found to have mediastinal exten- sion of a pancreatic pseudocyst
through the esophageal- ​aortic hiatus. A 74-year-old patient referred for an enlarging
posterior mediastinal mass had bilateral Bochdalek hernias containing only omental ​fat disclosed by CT. No further evaluation was required (fig. 6).
An asymptomatic 50-year- ​old man with a large middle and posterior mediastinal mass ​had a sliding hiatal hernia on upper gastrointestinal study
AJR:134, April 1980 ​CT OF BENIGN MEDIASTINAL ABNORMALITIES ​691

Fig. 6.-Focal fatty mediastinal masses in asymptomatic 72-year-old man ​referred for further evaluation
of posterior mediastinal mass. Posteroanterior (A) and lateral (B) films. Left retrocardiac mass
(arrows) b ​ est seen on the lateral view where two smooth densities were observed (​ arrowheads,
arrow) i​ n relation to diaphragms. Diaphragmatic-based lesion or posterior medias- t​ inal mass
was suspected. ​C, ​Bilateral, homogeneous, well encapsulated ​masses of fatty origin
(arrows) (​ - ​128 H) extend to right and left of spine. No ​other subdiaphragmatic contents were
demonstrated extending from abdo- men into t​ his ​area. Presumptive diagnosis o​ f bilateral
Bochdalek hernias containing only omentum was made and patient was discharged for clinical follow-up.
C =​ ​inferior vena cava; A ​= ​descending aorta.

C

which accounted for only one-third of his chest lesion. CT showed that the
rest was homogeneous fat, probably her- ​niated omentum. In a third patient, a
CT diagnosis of me- ​diastinal omental herniation through the esophageal hiatus
was confirmed by surgery for unrelated peptic ulcer disease. A 46-year-old man
with acute and chronic pancreatitis had ​bilateral pancreatic pleural effusions
requiring chest tube drainage. Extensive evaluation for a mediastinal
pseudocyst or a pancreaticopleural fistula including upper gastrointes-
tinal study, ultrasound, and endoscopic retrograde cholan-
giopancreatography revealed only a 2 cm pseudocyst in the pancreatic
body. Prior to elective surgery, CT demonstrated a large multilocular
pancreatic pseudocyst extending through the esophageal-aortic hiatus into
the posterior me- diastinum (fig. 7).
692 ​PUGATCH ET AL. A ​ JA:134, April 1980
A posterior superior mediastinal mass in an asymptomatic
euthyroid patient was investigated with CT to further define the ​anatomic
location of the lesion and to exclude the ​unlikely possibility of a vascular
abnormality. CT demon- strated a high density lesion continuous with an
enlarged right lobe of the thyroid. An ​1311 ​study confirmed a medias- tinal goiter.
Discussio
n
Vascular vs. Nonvascular Masses
CT offers many advantages when compared with conven- tional
radiography in evaluating mediastinal mass lesions ​and focal mediastinal
widening [5-7]. Conventional radio- graphic studies are rarely diagnostic and a
clear-cut distinc- tion among cystic, solid, vascular, or ​fatty lesions is often
 CD

Fig. 7.-Mediastinal pseudocyst In 46-year-old man with acute pancreatitis. A, Posteroanterior film. Left pleural effusion. Thoracentesis revealed a pleural fluid amylase in excess of 50,000 Somogyl units. Similar
process developed in right pleural space after chest tube drainage on left. Diagnosis of either panCreatlCopleural fistula or mediastinal extension of pancreatic pseudocyst was considered. Upper gastrointestinal study, gray
scale ultrasound, and endoscoplc retrograde cholangiopancreatography only demonstrated 2 cm cyst in pancreatic body. B, Well demarcated pancreatic pseudocyst ​(arrows) ​behind left lobe of liver and anterior to abdominal
aorta (A). Nasogastric tube ​(curved arrow) a​ ccounts for high density within stomach. K =​ ​right kidney. C, Slightly ​cephalad, cyst becomes more complex ​(arrows), ​extending through thoracoabdominal junction and
displacing nasogastric-tube-containing esophagus (E) anteriorly from its usual relation to aorta (A). Smaller component of cyst is seen anteriorly on left ​(arrowheads). B
​ ilateral pleural effusions. D, lntraoperative
cystogram next morning confirms CT findings. Complex pancreatic pseudocyst (​ arrows) ​extends into posterior mediastinum.
the extent of disease, and in some instances
obviate invasive procedures such as mediastinoscopy and thoracotomy.
Prior to thoracic CT, vessels within the mediastinum were indistinguishable
difficult. Using CT, a lesion suspected on the chest radio- graph is easily
from other structures without the use of intravenous or intraarterial contrast agents
confirmed and its relation to or origin from normal mediastinal structures
or isotopes. With 2 sec scanning, the normal great vessels are easily identified
determined. In addition, atten- uation numbers permit the identification of fatty,
vascular, and some cystic lesions. This may allow a precise diagnosis, determine
 AJR:134, April 1980 ​CT OF BENIGN MEDIASTINAL ABNORMALITIES ​693
in about 90% of patients because of their contrast with adjacent
mediastinal fat. Throughout the mediastinum, but especially superiorly on
the right, vascular causes of ​me- diastinal widening are frequently encountered.
Their distinc- ​tion from solid neoplasms is of obvious importance [3]. Serial
CT scans clearly depict the enlarged vascular struc- ture, producing a
rightward or leftward displacement of the mediastinal pleura either
directly or by a shift of the superior vena cava on the right (fig. 1​). ​When
necessary, rapid intravenous injection of contrast material with immediate
scanning will enhance vascular attenuation in the aorta and great vessels.
In our experience, solid thoracic or medias- ​tinal lesions do not enhance to a
similar degree. Vascular ​enhancement after intravenous contrast injection is
grossly ​visible and attenuation determinations are usually unnec- essary. Chronic
thrombosis in association with an aneurysm is not uncommon and appears as a
low density area sur- rounding and paralleling the tubular course of the true
lumen. Although tumor encasing a great vessel cannot be ​absolutely excluded,
such a combination is exceedingly rare. If aneurysmectomy is considered,
the information pro- vided by CT may be inadequate for proper surgical
planning, and appropriate angiography will be required to better vis- ualize
the origin and course of the great vessels. Angiogra- ​phy should also be
performed in the infrequent, complex case ​where CT is unable to clearly
differentiate vascular ​from nonvascular lesions.
Cystic Masses
A large number of cystic lesions has been described in ​the mediastinum
which may produce symptoms because of their proximity to adjacent vital
structures [8-1 0]. In this setting, CT may be performed to assist
percutaneous guided a​ spiration or to clarify the relations of the mass to adjacent
mediastinal contents prior to thoracotomy. The radiologist should be
cautious in interpretation of the significance of attenuation coefficients of
mediastinal cystic lesions, since these are not diagnostic and must be
correlated with other radiographic and clinical findings. We are following
four patients with presumed cysts. These patients remain asymp- tomatic
with stable chest radiographs from 6 months to 3 years after initial
detection. We believe that thoracotomy may be avoided in asymptomatic
patients with mediastinal cysts shown by CT.
Fatty Lesions
Many lesions of the mediastinum may be partially or ​entirely
composed of fat [1 1 ​, ​1 2]. We believe that the similar ​CT appearance in all but
one of our 16 cases including characteristic attenuation coefficients
confirms their fatty ​origin and correlates well with previously published findings
[13-15]. Of these homogeneous fat density abnormalities, ​six were localized
and well encapsulated posterior medias- tinal or paraspinal masses (fig. ​6), f​ our
diffusely involved the superior mediastinum (fig. 2), two were limited to the left
superior mediastinum above the aortic arch, two repre- ​sented epicardial fat
collections, and one was a localized
anterior mediastinal mass. Many of these patients were clinically obese and also
694 PUGATCH ET AL. ​AJR:134, April 1980
2. Benjamin SP, McCormack UT, Effler DB, Groves LK. Primary
demonstrated bilateral subpieural fat deposition and large epicardial fat
collections on their ​chest films and CT scans. One patient with an
inhomoge- neous posterior mediastinal mass had omental herniation
confirmed at thoracotomy. We believe patients with evi- ​dence of focal
mediastinal or paraspinal widening should ​have mediastinal fat deposition
excluded by ​CT before more i​ nvasive procedures are performed. Thymolipomas
can be ​suggested on the basis of clinical, conventional radiologic, a​ nd chest
CT findings, and dermoid tumors suspected when calcification and fat are
demonstrated within an anterior mediastinal mass.
Paravertebral Widening
Paravertebral or paraspinal widening is most frequently due to tumors of
neural origin, infection or neoplasm involv- ing the thoracic spine, paraspinal
lymphadenopathy, and ​less frequently vascular abnormalities that displace
the over- ​lying pleural reflections [1 6]. CT is especially useful when an
abnormality is located at the thoracoabdominal junction. Vascular abnormalities
can be easily documented with or without contrast enhancement by determining
vascular anatomy on serial scans (fig. 5). Herniation of intraabdom- inal fat is
easily diagnosed (fig. 6). Extension of pancreatic disease into the mediastinum is
also visible (fig. 7).
Our experience with CT in detecting vertebral abnormali- ties suggests that
plain radiographs in conjunction with nuclear scanning remain the primary
methods for accurately detecting and evaluating diseases involving the thoracic
spine, while CT is superior for imaging the paraspinal com- ponent of vertebral
disease. CT-guided aspiration biopsy at this site is justified when fluoroscopic
visualization is poor or when intimacy of a lesion to the great vessels precludes
safe fluoroscopic access.
Mediastinal Lymphadenopathy
We believe that CT cannot distinguish benign from malig- ​nant
mediastinal lymphadenopathy, although ​other associ- a​ ted CT findings may
support one or the other diagnosis.
Conclusio
ns
We believe that CT should be the initial procedure in ​evaluating most
patients with mediastinal abnormalities on plain chest film. If the patient is
asymptomatic and the information provided by ​CT indicates a benign process,
conservative management with careful follow-up is justified. When a malignant
process is suspected, CT is useful in excluding vascular abnormalities, defining
the anatomic re- lationships of the lesion, and directing biopsy procedures.
REFERENC
ES
1. Oldham HN Jr. Mediastinal tumors and cysts. ​Ann Thorac Surg
1971;1 ​1:246-275
tumors of the mediastinum. ​Chest 1​ 972;62:297-303 ​3. Kalter YE,
Liebermann Y, Pauzner YM. Pitfalls in diagnosis of
​ 964;46:174-180 ​4. Pugatch AD, Braver JH,
mediastinal tumors. ​Chest 1
Aobbins AH, Faling ​U. CT diagnosis
of pericardial ​cysts. ​AJR 1​ 978;1 31:515-516 ​5. Goldwin AL,
Heitzman ER, Proto AV. Computed tomography
of the mediastinum. ​Radiology 1​ 977;124:235-243 6. Jost AG, Sagel ​SS,
Stanley AJ, Levitt AG. Computed tomog-
raphy of the thorax. ​Radiology 1​ 978;1 26:125-136 ​7. ​Crowe JK, Brown
LA, Muhm JA. Computed tomography of the
mediastinum. ​Radiology ​1978;1 28:75-89 ​8. Reed JC, Sobnya RE.
Morphologic analysis of foregut cysts in
the thorax. ​AJR 1​ 974;1 20:851-860 9. Pachter MA, Laites A.
Mediastinal cysts: a clinicopathologic
study of twenty cases. ​Chest 1​ ​963;44 :416-422
1 0. Feigin ​DS,
Fenoglio JJ, McAllister HA, Madewell JE. Pericar-
dial cysts: a radiologic-pathologic correlation and review. ​Ra- diology ​1977;1
25:15-20 ​11. Felson B: ​Chest roentgenology. P​ hiladelphia: Saunders, 1973 ​12. Case
records of the Massachusetts General Hospital (Case
​ 977;296:1467-1473 ​13. Aohlfing BM,
25-1977). ​NEngIJ Med 1
Korobkin M, Hall ​AD. Computed tomography of
intrathoracic omental herniation and other mediastinal fatty masses. ​J Comput
Assist Tomogr 1​ 977;1 :181-183 ​14. Homer MT. Wechsler AJ, Carter BU.
Mediastinal lipomatosis.
Radiology ​1978;1 28:657-661 ​15. ​Faer JF, Butnam RE, Beck CL.
Transmural thoracic lipoma:
demonstration by computed tomography. ​AJR 1​ 978;1 30:161 ​- ​163 ​16. ​Heitzman
ER. ​The mediastinum: radiologic correlations with
anatomy and pathology. S
​ t. Louis: Mosby, 1977