Age / Sex : 19 / M

Ganglioneuroma

Discussion

Findings:

<Chest CT>

- A well-defined, homogeneous soft tissue mass in right upper paravertebral region (T1-3)

- No internal calcification or fatty attenuation

- No adjacent pleural thickening or bony destruction
 

<Thoracic spine MRI>

- A well-defined, soft tissue mass in right paravertebral space, upper posterior mediastinum, at T1-T3 upper body level

- The mass shows homogeneous isointense signal on T1WI and inhomogeneous iso- to hyperintense signal on T2WI, with mild contrast enhancement on postcontrast fat-suppressed T1WI.

- Right T1 nerve is posterosuperiorly displaced with partial abutment.

Differential Diagnosis:

- Neurogenic tumor

- Bronchogenic cyst 

Diagnosis: Ganglioneuroma 

Discussion:

1. Introduction

- Rare, benign neurogenic tumors arise from sympathetic ganglia

- Composed of mature Schwann cells, ganglion cells, nerve fibers

- Arise anywhere along paravertebral sympathetic plexus and from adrenal medulla

- M/C: Posterior mediastinum (39 – 43 %) and Retroperitoneum (32 – 52 %)

- Paravertebral ganglioneuromas

 : Frequently extend through neural foramina to involve the epidural space 

Intradural extramedullary ganglioneuromas: extremely rare

- Predominantly children and young adults (42%–60%)

- Prognosis: excellent (recurrence: rare after surgical resection)

2. Imaging Finding

1) CT

- Well-circumscribed, solid, oval, crescentic, lobulated, encapsulated mass

- Iso- to hypoattenuating to muscle

- Fine and speckled, but coarse calcifications (20%)

2) MRI

- T1WI: homogeneously low or intermediate SI

- T2WI: heterogeneously intermediate or high SI

- CE T1WI: variable ranging from none to heterogeneous enhancement,

gradual increasing enhancement on dynamic images

References:

- Guan YB, Zhang WD, Zeng QS, Chen GQ, He JX. CT and MRI findings of thoracic ganglioneuroma. Br J Radiol 2012;85: e365-72.

- Kizildag B, Alar T, Karatag O, Kosar S, Akman T, Cosar M. A case of posterior mediastinal ganglioneuroma: the importance of preoperative multiplanar radiological imaging. Balkan Med J 2013;30: 126-8.

- Duffy S, Jhaveri M, Scudierre J, Cochran E, Huckman M. MR imaging of a posterior mediastinal ganglioneuroma: fat as a useful diagnostic sign. AJNR Am J Neuroradiol 2005;26: 2658-62.