Pathologic Quiz Case 1
Wade R. Cressman, MD, Charles M. Myer III, MD, Cincinnati, Ohio
An 8-year-old boy presented with an expansile right-sided neck mass. This had been noted several weeks previously during an episode of straining. The physical examination showed nothing abnormal except when the patient performed a Valsalva maneuver, when a soft mass deep to the right sternocleidomastoid in the midcervical region was palpable (Fig 1).
A computed tomographic scan demonstrated a 7x5x8-cm, multiseptated, contrast-enhancing mass in the anterior mediastinum with extension superiorly to the thoracic inlet with mild compression of the intrathoracic trachea (Fig 2). With the Valsalva maneuver, this mass was visualized deep to the right sternocleidomastoid muscle, extending from the hyoid to the thoracic inlet, displacing the right carotid sheath posteriorly and the trachea leftward. No adenopathy or bony erosion was evident.
The patient was taken to the operating room, where, through a low
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