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My, what a big thymus you have! Neonate/infant mediastinal masses
Case presentation
An 8-month-old male presents with 2 months of cough and intermittent rhinorrhea. He has been seen multiple times by his primary care provider and has been diagnosed at various times with viral upper respiratory tract infection and acute otitis media, for which he has been prescribed oral antibiotics. He has had some intermittent fevers as well, all of which have resolved after several days. There has been no travel or sick contacts, nor has there been any history of choking or concern for foreign body ingestion.
Physical examination reveals a thin but well-appearing and active child. He is afebrile and his vital signs are unremarkable, except for mild tachypnea (65 breaths per minute). There is no rhinorrhea and the oropharynx is clear. His chest demonstrates decreased breath sounds to the upper left chest, but there are no crackles, retractions, grunting, or stridor. He has a normal abdominal examination.
Imaging considerations
Plain radiography
This imaging modality is the most commonly utilized imaging modality for the neonatal or infant chest. Two views are preferred (anterior-posterior [AP] and lateral) when possible. Plain radiography may suggest the presence of a chest mass, prompting the use of advanced imaging. Ninety percent of chest masses can be visualized by plain radiography.
Plain radiography is the first-line imaging modality when chest masses are suspected. However, this modality may miss small masses, and further imaging is indicated when a mediastinal mass is suspected, since a diagnosis is not usually made by plain radiography alone.
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