Case report: enlargement of a mediastinal mass during treatment for Hodgkin's disease may be due to accumulation of fluid within thymic cysts.

Abstract

A patient with Hodgkin's Disease (HD) is described as one in whom a mediastinal mass showed progressive enlargement during the first two cycles of chemotherapy owing to accumulation of fluid within thymic cysts. This phenomenon was identified by computed tomography. Dependence on plain radiography would have led to an erroneous diagnosis of progressive HD. We suggest that in all cases of mediastinal HD, apparent failure to respond to treatment must be further investigated by computed tomography or magnetic resonance imaging. Such a policy should avoid unnecessary changes in therapy when enlargement of thymic cysts causing mediastinal widening is mistakenly interpreted as being due to progressive disease.