Answer of October 2002

Clinical History:

M/18, cough with blood stained sputum for 2 weeks.

Figure 1: Frontal chest radiograph.
Figure 2: Noncontrast axial CT scan of thorax.
Figure 3: Contrast axial CT scan of thorax.

                                 Figure 1

                                 Figure 2

                                 Figure 3

Diagnosis:

Choriocarcinoma of mediastinum with lung metastases.

Discussion:

Figure 1: Frontal chest radiograph shows mediastinal widening with multiple "cannon ball" lesions in both lungs, more in the lower zones.

Figure 2 and 3: CT thorax shows an non-calcified solid anterior mediastinal mass slightly hypodense to the surrounding medistinal structure and with heterogeneous enhancement. Multiple nodules are seen in both lungs.