11 year old boy presented with a large lt sided cervical swelling with facial congestion for 3 months. No other associated symptoms. On examination, the swelling is soft, oval, measuring 18*15 cm, on the lot side of the neck, extending to the mediastinum, causing tracheal shift to the right. No axillary or inguinal lymph node enlargement. No hepatosplenomegaly. All blood investigations done 3 months ago were done and showed nothing abnormal. Ultrasound shows enlarged cervical lymph nodes. X-ray as shown above. Patient was admitted for further assessment. What is your plan?

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Enlarged thymus shadow rt upper zone. Cystic hygroma neck lt side. Adv. FNAC OF THE SWELLING of neck CT SCAN OF NECK AND CHEST LATERAL VIEW of X-RAY OF CHEST Transillumination TEST of the neck swelling Posting a image of the neck swelling could have been better

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It's mass in mediastinum extending more on right laterally and in right neck with features of compressions (facial congestion). So plan should be HTCT with guided FNAC. Cervical mass fnac/biopsy to be done urgently. Most probably we are dealing with a case of NHL. Steroids can be started to reduce the compressions. Please keep the baby admitted till diagnosis (may need intubation). Please keep us updated.

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CXR SHOWS : RIGHT SIDE MEDIASTINAL MASS. Clincally left side Neck Swelling 18 x 15 cms. Work up with CORE BIOPSY. MRI CHEST. D/D : HODGKIN'S LYMPHOMA. NON-HODGKINS LYMPHOMA. LEUKEMIA. RX : ACCORDINGLY.

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Xray suggest Large lobulated soft tissue lesion in right upper zone mostly right paratracheal region in a child of 11years but clinical findings suggest left sided cervical swelling extension to mediastinum in D/D considerations like lymphoma, cystic hygroma,thymoma, tubercular,are thought of.Biopsy/FNAC will guide the diagnosis

Soft swelling Lt side of neck young boy of 11 D/D cystic hygroma, HL, thymoma, Advise FNAC/ trucut Bx, CT chest.

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As history looks huge mass inrt upper & middle lung dislacing trachea lt cervical lyumpnode is metastatic or primary infection pet scan broncoscopic biopsy HP lyumphoma Hodgkin or large carcinoma of lung

Advised biopsy so that further investigations and treatment r planned
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Large well defined radio opaque lesion with broad base towards mediastinum silhouetting ascending aorta suggestive of anterior medistinal mass. Possibility of Lymphnodal mass Teratoma Thymoma ( less likely.. age is not favouring) Fibrolipoma ( rare cause)

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Enlarged thymic shadow right. Enlarged cervical lymhnodes left. Advised lateral view of chest.

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Rt side on homogenous opacity extended to left side also. Inxray chest . Clinically swelling is on left side. Sign of compression are there. Superior Mediastinum syndrome should be in mind Lymphoma is one. CT chest can confirm diagnosis.

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