LUNG AND MEDIASTINAL

MASSES
Lia Pramita
I4061191023
P e m b i m b i n g : dr. I n d r i a Fa jrianita , Sp.Rad
 ANATOMY
• T h e wh i t e line d e m a r c a t e s t h e a p p r o x i m a t e level of t h e
m i n o r o r h o r i z o n t a l f i ss ure , w hi c h is usually visible i n t h e
f r on t a l view b e c a u s e it is s e e n o n e nd. T h e r e is n o m i n o r
fi s sur e o n t h e left side.
• T h e w h i t e circle c o n t a i n s l u n g m a r k i n g s t h a t a r e bl ood
vessels.
• T h e left h i l u m is n o r m a l l y slightly h i g he r t h a n t h e right.
LATERAL VIEW
 CT ANATOMY

Axial (A), coronal (B), a n d s agi tt al (C) views of t h e t ho rax . T h e t h r e e s t a n d a r d p l a n e s for

i m a g i n g t h e t h o r a x a re s h o w n above. T h e left m a i n b r o n c h u s (black ar r o w ) a n d t h e
r i g h t m a i n b r o n c h u s ( w hi t e ar r o w ) c a n be s e e n i n (A). Ao, Aorta; LA, left a t r i u m ; LV,
left ventricle; PA, p u l m o n a r y art ery; RA, r i g h t a t r i u m ; S, s u p e r i o r v e n a cava.
 MEDIASTINUM
T h e m e d i a s t i n u m c a n be arbitrarily s ubdivided i n t o t h r e e
c o m p a r t m e n t s : a n te r i o r, mi d d l e, a n d p osterior .

1. T h e a n t e r i o r m e d i a s t i n u m is t h e c o m p a r t m e n t t h a t
e x t e n d s f r o m t h e back of t h e s t e r n u m t o t h e a n t e r i o r
b o r d e r of t h e h e a r t a n d g r e a t vessels (A).
2. T h e m i dd l e m e d i a s t i n u m is t h e c o m p a r t m e n t t h a t
e x t e n d s f r o m t h e a n t e r i o r b o r d e r of t h e h e a r t a n d a o r t a
t o t h e p os t e ri or b o rd er of t h e h e a r t a n d ori gins of t h e
g r e a t vessels (M).
3. T h e p os t eri o r m e d i a s t i n u m is t h e c o m p a r t m e n t t h a t
e x t e n d s f r o m t h e p os t eri or b o r d e r of t h e h e a r t t o t h e
a n t e r i o r b o r d e r of t h e vertebral c o l u m n (P).
 MEDIASTINUM
R eco n s t ruc t ed lateral t h o r a x CT s h o w s 3 m a i n a n d 9 s u b
c o m p a r t m e n t s of t h e m e d i a s t i n u m .
Abbreviations: C, C o m p a r t m e n t ; T, Thoracic; V, Vertebrae.

1. Anterior s u p e ri o r C.,
2. Anterior Central C,
3. Anterior Inferi or C,
4. Middle S uperi or C.,
5. Middle C entral C,
6. Middle Inferi or C,
7. P os teri or S uperi or C.,
8. P os teri or Central C,
9. P os teri or Inferi or C.
ANTERIOR MEDIASTINAL
MASSES
 ANTERIOR MEDIASTINAL MASSES

Mass (4T) What to Look for

Thyroid goiter The only anterior mediastinal mass that

routinely deviates the trachea
Terrible lymphoma or Lobulated, polycyclic mass, frequently asymmetric,
Lymphoma (lymphadenopathy) that may occur in any compartment of the
mediastinum
Thymoma Look for a well-marginated mass that may
be associated with myasthenia gravis
Teratoma Well-marginated mass that may contain fat
and calcium, especially seen on
computed tomography scans
1. THYROID MASSES
Massa tiroid substernal.

• Ku tu b b a w a h tiroid b isa m e m b e s a r t e t a p i
m e n o n j o l ke b a w a h t h o r a x b a g i a n a t a s (oval
p u t i h ) d a r i p a d a ke a n t e r i o r ke leher.
• Menghasilkan ma s s a med iastin um yang tidak
m e l u a s di b a w a h p u n c a k l e n g k u n g a o r t a
( p a n a h p u ti h ).
• Secara k h a s m e n g g e s e r t ra k e a ( p a n a h h i t a m )
ke kiri a t a u k a n a n di a t a s a ortic k n o b ,
kecenderungan yang biasanya ti d a k
d i t u n j u k k a n o l e h m a s s a m e d i a s t i n a l a n t e ri o r
lainn ya .
 CT Scan substernal thyroid goiter

Dua g a m b a r p a d a t i n g k a t y a n g s a m a p a d a p a s i e n y a n g dipindai s e b e l u m (A) d a n s et e l ah p e m b e r i a n

k o n t r a s i n t r a v e n a (B). P a d a CT s c a n m a s s a tiroid s u b s t e r n a l ( p a n a h p u t i h solid) b e r d e k a t a n d e n g a n
kel enj ar tiroid, s e r i n g m e n g a n d u n g kalsifikasi ( p a n a h p u t i h p u t u s - p u t u s ) , d a n
(B) P e m b e r i a n k o n t r a s i n t r a v e n a m e n u n j u k k a n t a m p i l a n t i da k h o m o g e n d a n b e r b i n t i k - b i n t i k ( p a n a h
p u t i h solid) . M a s s a ini m e n g g e s e r t ra k e a (T) sedikit ke kiri.
Calcified Thyroid Adenoma. The frontal chest radiograph shows a calcified structure in the left side of the lower neck,
upper chest which has both peripheral and internal calcifications (white arrows). The CT scan on the same patient shows a
large substernal thyroid (red arrows) displacing the trachea to the right (black arrow) and containing a large degenerated
thyroid adenoma (yellow arrow)
2. LYMPHOMA
L i m fad eno pat i m e d i a s t i n u m a n t e r i o r p al i n g s e r i ng terjadi
p a d a Hodgkin Lymphoma, t e r u t a m a jenis sklerosis
nodular.

Hodgkin Lymphoma
• L i m fa den op at i s e r i n g m u n c u l d e n g a n b a t a s berl obus
a t a u polisiklik s ebagai ak ib at d a r i k o n g l o m e r a s i n o d u s
yang membesar yang menghasilkan massa (panah putih
solid).
• Bias anya bilateral ( p a n a h p u t i h p u t u s - p u t u s ) d a n
s eringkali as i metris .
CT Scan Hodgkin Lymphoma

• L i m f o m a a k a n b erm u lt i pl e , m a s s a j a ri n g a n
l u n a k berlobus a t a u m a s s a j a r i n g a n l u n a k y a n g
b e s a r dari agregasi kel enj ar g e t a h b e n i n g
( p a n a h puti h).

• M a s s a b i as a nya h o m o g e n d a l a m k e p a d a t a n ,
s e per t i d a l a m k a s u s ini, t e t a p i m u n g k i n
h e t e r o g e n ketika n o d e m e n c a p a i u k u r a n y a n g
c u k u p u n t u k m e n g a l a m i n ekro s i s ( a re a d e n g a n
a t e n u a s i r e n d a h , yaitu lebih h i t a m ) , a t a u
p e r d a r a h a n (area a t e n u a s i tinggi, yai tu lebih
putih) .
Non Hodgkin Lymphoma
3. THYMIC MASSES

Timoma a d a l a h n e o p l a s m a epitel t i m u s d a n
limfosit y a n g p al i n g s er i n g terjadi p a d a o r a n g
d e w a s a p a r u h baya, u m u m n y a p a d a us ia y a n g
lebih t u a d i b a n d i n g k a n d e n g a n t e r a t o m a .

(A) Foto thoraks menunjukkan massa

mediastinum anterior berbatas halus (panah
hitam).
CT Scan Thymoma

(B) CT s c a n d e n g a n k o n t r a s m e m a s t i k a n lokasi
mediastinal anterior dan kepadatan massa yang
h o m o g e n ( p a n a h putih). P a s i en m e n d e r i t a
m i a s t e n i a gravis d a n m e m b a i k s e t el a h reseksi
timoma.

Ascending a o r t a (A), d es c e n d i n g a o r t a (Ao), m a i n

p u l m o n a r y art ery (PA), s up eri o r v e n a cava (SVC).
4. TERATOMA

Te r a t o m a a d a l a h t u m o r g e r m i n a l y a n g b i as a nya
m e n g a n d u n g ketiga l a pi s an g e r m i n a l , c e n d e r u n g
d i t e m u k a n p a d a usi a y a n g lebih m u d a
dibandingkan dengan timoma.

Variasi t e r a t o m a y a n g p al i n g u m u m a d a l a h kistik,
s e pert i d a l a m k a s u s ini ( p a n a h p u t i h solid),
m e n g h a s i l k a n m a s s a y a n g b e r b a t a s t e g a s di
d a e r a h p e m b u l u h d a r a h besar.

P a d a CT, s e cara k h a s m e n g a n d u n g l e m a k ( p a n a h
h i t a m solid), t u l a n g r a w a n , d a n t e r k a d a n g t u l a n g
(panah putih putus-putus).
Mediastinal Teratoma

A mass obscures the ascending

thoracic aorta and upper left heart
border (yellow line) on the PA view,
placing it in the anterior
mediastinum. The lateral view
confirms this. No calcifications are
visible.
MIDDLE MEDIASTINAL
MASSES
LYMPHADENOPATHY

M e s k i p u n l i m f o m a a d a l a h p en ye b a b p al i n g
m u n g k i n d ari a d e n o p a t i di m e d i a s t i n u m m ed i al ,
k e g a n a s a n lain s ep ert i k a r s i n o m a p a r u sel
kecil, p en y a k i t m e t a s t a s i s , d a n b e b er a p a
p en ya k i t jinak d a p a t m e n g h a s i l k a n t e m u a n ini.

P as i en ini m em il i ki m a s s a m e d i a s t i n u m y a n g
d i t u n j u k k a n p a d a t a m p i l a n fr o n t a l (A) ( p a n a h
p u t i h solid) d a n lateral
LYMPHADENOPATHY

(B) ( p a n a h h i t a m solid). M a s s a m e n d o r o n g
t r a k e a ke d e p a n ( p a n a h p u t i h p u t u s - p u t u s ) p a d a
t a m p i l a n s a m p i n g . Kelenjar g e t a h b e n i n g y a n g
dibiopsi p a d a p a s i e n ini m e n u n j u k k a n
k a r s i n o m a sel kecil paru.
LYMPHADENOPATHY

P en yeb ab jinak dari l i m f ad en o pa t i m e d i a s t i n u m

termasuk infeksi m o n o n u k l e o s i s dan
t uberkul os is , y a n g bi as an ya m e n y e b a b k a n
a d e n o p a t i m e d i a s t i n u m unilateral.
Hilar lymphadenopathy in a patient with TB
.
 POSTERIOR
MEDIASTINAL
MASSES
NEUROGENIC TUMOR
Tu m o r n e u r o g e n i k a k a n m e n g h a s i l k a n m a s s a j a r i n g a n l un ak , b i as any a b e rb a t a s t a j a m , di
pa rav ert eb ral gut ter. T u m o r jinak d a n g a n a s d a p a t m e n g i k i s t u l a n g r u s u k y a n g b e r d e k a t a n , d a p a t
m e m p e r b e s a r f o r a m e n s araf, m e n g h a s i l k a n lesi b e r b e n t u k h a l t e r ( d u m b b e l l - s h a p e d les ions)
y a n g m u n c u l d ari k a n a l t u l a n g b e l a ka n g t et a pi m e n o n j o l mel al ui f o r a m e n s araf ke d a l a m
mediastinum.
 Neurofibromatosis

N e u r o fi b r o m a d a p a t s ebagai t u m o r terisolasi y a n g t i m b u l dari sel S c h w a n n s e l u b u n g s araf a t a u

sebagai b ag i a n s i n d r o m n e u r o fi b r o m a t o s i s , s epe rt i d a l a m k a s u s ini. N e u r o f i b r o m a m e d i a s t i n u m
po s t eri o r b e s a r ( p a n a h p u t i h ) t e rl i ha t di g u t t e r paravertebral is k a n a n fron t al (A) d a n lateral (B).
Neurofibromatosis

A, n e u r o f i b r o m a P lexiform d a p a t m e n g h a s i l k a n
erosi di s e p a n j a n g b a t a s inferior t u l a n g r u s u k (di
m a n a s ara f i n t er kos t al b er a d a ) d a n m e n g h a s i l k a n
takik a t a u t a m p i l a n b e rg e l o m b a n g y a n g d i s eb ut
pi t a ribs ( p a n a h p u t i h padat).
Neurofibromatosis

B, P as i e n l ain m e n u n j u k k a n n e u r o f i b r o m a b e s ar
y a n g m e m p e r b e s a r f o r a m e n s araf, m e n g i k i s
s e t e n g a h dari t u b u h vert ebral ( p a n a h h i t a m
pe kat ) , d a n m e n g h a s i l k a n lesi b e r b e n t u k h a l t e r
y a n g m u n c u l dari k a n a l t u l a n g b e l a ka ng t e t a p i
m e n o n j o l m el al ui f o r a m e n ke m e d i a s t i n u m
(bertitik p a n a h put ih).
MASS IN THE
LUNG
BENIGN CAUSES OF SOLITARY PULMONARY NODULES

A, g r a n u l o m a t uberkul os is a d a l a h gejala s isa y a n g

u m u m dari infeksi t u be rku l os i s s e b e l u m n y a ,
bi as an ya subklinis, d a n bi a s an ya kalsifikasi s eca ra
hom ogen (lingkaran hitam).
B, Histoplasmoma (panah putih) dapat
m e n g a n d u n g kalsifikasi s e n t r a l a t a u t a rg e t
( p a n a h h i t a m ) a t a u d a p a t m em i l ik i kalsifikasi
berlapis, y a n g bers ifat diagnos tik.

CT d a p a t d i g u n a k a n u n t u k m e m b e d a k a n a n t a r a
n o d u l p a r u y a n g m e n g a l a m i kalsifikasi d a n
nonkalsifikasi d e n g a n s ens i ti vi tas y a n g lebih
b es a r d a ri p a d a radiografi konvens ional.
 Hamartoma

H a m a r t o m a p a r u a d a l a h t u m o r y a n g t e rl et ak di
peri fer dari j ar i n g a n p a r u - p a r u y a n g t idak
t e r a t u r y a n g s eca ra klasik m e n g a n d u n g l e m a k
d a n kalsifikasi p a d a CT s can.

Kalsifikasi klasik h a m a r t o m a di s e bu t kalsifikasi

p o p c o r n ( p a n a h put ih). P u l au kecil j ar i n g a n
l u n a k di t e n g a h p a r u - p a r u k a n a n (D) a d a l a h
b ag i a n p al i ng a t a s dari h e m i d i a f r a g m a k a n a n .
CARCINOMA OF THE LUNG: CELL
TYPES
Squamous Cell Carcinoma

K a r s i n o m a b r o n k o g e n i k kavitas. Ada n e o p l a s m a
kavitasi b es a r di l obus k a n a n a t a s d e n g a n d i n d i n g
t ebal ( p a n a h put ih). Tepi l u a r lesi spikulasi. K o n t ur
i n t e r n a l r o n g g a a d a l a h n o d u l a r ( p a n a h h i t a m ) . Ci ri -
ciri ini m e n g a r a h ke k e g a n a s a n kavitasi.

Bronchogenic Carcinomas Presenting as a

Nodule/Mass in the Lung
K a rs i n o m a sel s k u a m o s a . A: F oto t h o r a k s PA dari s e o r a n g w a n i t a 6 2 t a h u n d e n g a n nyeri d a d a kiri
m e n u n j u k k a n m a s s a y a n g ti dak jelas d e n g a n lucency s e n t r a l di p e r t e n g a h a n p a r u kiri. B: Ta m p i l a n
lateral m e m a s t i k a n b a h w a m a s s a ini b e r a d a di s e g m e n s u p e r i o r dari lobus kiri b a w a h ( p a n a h ) .
Bronchogenic Carcinoma Presenting with
Bronchial Obstruction

Atelektasis lobus kanan atas dan massa hilar: S s i gn

of Golden. Ada m a s s a j ar i n g a n l u n a k di h i l us k a n a n
(panah putih padat) yang menyebabkan kekeruhan
l obus k a n a n a t a s dari atelektasis.

F isura m i n o r b erg es e r ke a t a s m e n u j u a r e a k e p a d a t a n
yang meningkat (panah putih put us-putus) yang
m e n u n j u k k a n h i l a n g n y a v o l u m e l obus k a n a n atas.

B en t uk t epi l e n g k u n g y a n g d i b e n t u k o l eh m a s s a d a n
celah m i n o r y a n g di t i n g gi ka n d i s e bu t S s i g n of
Golden. P as i e n m em i l i ki k a r s i n o m a sel s k u a m o s a
b e s ar y a n g m e n g h a l a n g i b r o n k u s lobus k a n a n atas.
 Bronchogenic Carcinoma Presenting with Direct
Extension or Metastatic Lesions

T u m o r p a n c o a s t , lobus k a n a n at as . Ada m a s s a
j a ri n g a n l u n a k y a n g b e s a r di p u n c a k p a r u -
p a r u k a n a n ( p a n a h put ih).

K e ru s a k a n t u l a n g r u s u k ( p a n a h h i t a m ) .

Di sisi kiri n o r m a l , t u l a n g r u s u k m a s i h u t u h
( p a n a h p u t i h bertitik).

P aling s e ri n g p a d a karsinoma sel

skuamosa atau adenokarsinoma
 Adenocarcinoma

K a rs i n o m a b ro n ko g en i k d e n g a n a d e n o p a t i hil ar d a n
m e di as t i na l . Ada m a s s a p a r u perifer ( p a n a h h i t a m
solid)

Adenopati hil ar d a n m e d i a s t i n a l ipsilateral ( p a n a h

p u t i h solid)

Adenopati m e d i a s t i n a l k o n t r a l a t er a l ( p a n a h p u t i h
putus-putus). Karsinoma bronkogenik dapat muncul
d e n g a n lesi m e t a s t a s i s y a n g d a p a t b e r m a n i f e s t as i di
o rg a n j a u h a t a u di t or a k s i tu sendiri.
Adenokarsinoma.

A. Foto t h o r a k s (PA) dari w a n i t a 75 t a h u n

m e n u n j u k k a n m a s s a di lobus k a n a n a t a s
berbatasan dengan mediastinum.
B. CT m e n u n j u k k a n m a s s a ( p a n a h ) y a n g m e n e k a n
v e n a kava s u p e r i o r (S).
C. M as s a ( p a n a h ) t e rl i ha t p a d a radiografi b a h u y a n g
di p ero l eh 3 b u l a n s e b e l u m n y a .
Adenokarsinoma.

F oto t h o r a k s PA dari s e o r a n g w a n i t a 73
t ahu n dengan suara serak dan sesak nafas
m e n u n j u k k a n plak pl e ura y a n g terkalsifikasi
( p a n a h ) d a n m a s s a y a n g t idak jelas di
l obus kiri a t a s (l ingkaran). Plak p l e u r a
berhubungan dengan paparan asbes
sebelumnya.
Adenokarsinoma.

A. Foto t h o r a k s PA s e o r a n g p ri a 4 8 t a h u n
m e n u n j u k k a n m a s s a y a n g ti dak t e r a t u r di
lobus k a n a n a t a s y a n g b e r b a t a s a n
dengan mediastinum.
B. CT m e n u n j u k k a n m a s s a y a n g m e l u a s ke
mediastinum. Pusat massa adalah
a t e n u a s i r e n d a h , s e k u n d e r ak i ba t
nek ros i s t u m o r.
C. CT p a d a t i n g k a t inferior (B) m e n u n j u k k a n
t u m o r di s e p a n j a n g d i n d i n g p os t eri o r
b r o n k u s l obus k a n a n atas.
D. CT d e n g a n l u n g w i n d o w s m e n u n j u k k a n
m a s s a spikulasi d a n l at a r b e l ak an g
e m f i s e m a p a r as e p t a l d a n sent rilobular.
Difference mediastinal and lung masses
TERIMA
KASIH
Resources
He rri ng , W., 2015, L earn i ng Radiology, Recognizing
t h e Basics 3rd Edition,. Elsevier