Superior

A 9 year old boy presents with mild facial swelling for 2 weeks, in association with a nonproductive cough. There was no history of fever, headache, rhinorrhea, or pruritis.

His mother had taken him to a primary care practitioner 1 week ago, who had subsequently prescribed antihistamines. These had not relieved his symptoms.

His mother mentions that he has also been somewhat tired and lethargic for the last couple of months.

His birth, medical, surgical and family histories are completely unremarkable. A full blood count, urinalysis, renal functions, and serum electrolytes are all found to be normal

Select Relevant Investigations
Chest X-Ray

Performed

There is a large mass in the superior mediastinum, causing mediastinal deviation towards the right.
MRI + MRA Thorax

Performed

MRI reveals the presence of a 6.2 x 5.3 x 5.1 cm homogenous soft-tissue mass in the superior mediastinum compressing the superior vena cava (SVC).
The mass is hypointense in T1 images and slightly hyperintense in T2 weighted images.
MRA shows partial thrombosis of the SVC.
Imaging guided FNAC

Performed

Fine needle aspiration cytology reveals the presence of plasma cells, eosinophils, and large atypical cells, including typical Reed-Sternberg cells.
Bronchoscopy

Performed

You realize that bronchoscopy is probably not indicated in this patient.

Select Relevant Management
Antibiotics
Diuretics
Vascular Stenting
Oncology Referral