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Is It A Case Of Superior Herniation Of Normal Mediastinal Thymus?

Saliha enel, Nilgün Erkek and Gökçe Çinar

Dr. Sami Ulus Children's Hospital Ankara, Turkey

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We have diagnosed two sibling cases of superior herniation of the normal mediastinal thymus, which are now being prepared for publication. This has caused us to note with interest the article by Wong et al. [1] in the American Journal of Roentgenology. The authors reported an interesting case of an unusual anterior neck mass visible only during Valsalva's maneuver. They described this as "superior herniation of normal mediastinal thymus." We do not agree with the authors' statement in this case. The appearance of a suprasternal mass continuous inferiorly with the normal thymus in the anterior superior mediastinum during normal breathing on MRI in their case is compatible with the cervical extension of the mediastinal thymus that is one of the seven basic forms of cervical ectopic thymus described by Zarbo et al. [2]. The superior herniation of the normal mediastinal thymus was defined as intermittent migration of the broadest part of the normal thymus out of the thorax into the suprasternal region during Valsalva's maneuver by Mandell et al. [3]. So we think that the bulging of contour in the anterior neck during Valsalva's maneuver in the case of Wong et al. is only the prominence of the ectopic thymus not migration of the normal mediastinal thymus.

References

1. Wong KT, Lee DLY, Chan MSM, Tsang RKY, Yuen EHY, Ahuja AT. Unusual anterior neck mass visible only during Valsalva's maneuver in a child. AJR 2005; 185:1355 –1357[Free Full Text]
2. Zarbo RJ, McClatchey KD, Areen RG, Baker SB. Thymopharyngeal duct cyst: a form of cervical thymus. Ann Otol Rhinol Laryngol 1983; 92(3 Pt 1): 284–289[Medline]
3. Mandell GA, Bellah RD, Boulden MEC, et al. Cervical trachea: dynamics in response to herniation of the normal thymus. Radiology 1993;186 : 383–386[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Senel, S. Articles by Çinar, G. Search for Related Content PubMed PubMed Citation Articles by Senel, S. Articles by Çinar, G. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?