(1780) Diffuse Large B-Cell Lymphoma Masquerading as a Mediastinal Hematoma After Motor Vehicle Collision

Tuesday, February 25, 2025

12:30pm – 1:30pm Eastern Time

Location: Connections Central - RST 03

First Author(s)

AS

Alyscia C. Severance, MD

USA

Co-Author(s)

HR

Hess M. Robertson, MD

Associate Professor of Anesthesiology, Vice Chair of Critical Care Anesthesiology
University of Mississippi Medical Center, United States
VH

Vincent E. Herrin, MD

Professor and Program Direct of Internal Medicine
University of Mississippi Medical Center, United States
JM

Jacob R. Moremen, MD FACS

Associate Professor of Surgery, Thoracic Surgery Division
University of Mississippi Medical Center, United States
LM

Larry C. Martin, MD

Associate Professor of Surgery
Ohio State University Wexner Medical Center, United States
MK

Matthew E. Kutcher, MD, MS

Associate Professor of Surgery and Emergency Medicine
University of Mississippi Medical Center
Jackson, Mississippi, United States

Introduction: The majority of traumatic chest injury occurs via a blunt mechanism. Routine CT imaging after central chest trauma sensitively detects mediastinal hematoma, associated with injuries ranging from sternal fracture site bleeding to blunt cardiac injury. These patients are often admitted to the ICU to monitor for hemodynamic changes and arrythmias. However, other mediastinal pathology may masquerade as an injury-related hematoma. Here we present a case of pre-existing diffuse large B cell lymphoma (DLBCL) with the initial appearance of a mediastinal hematoma after chest injury.

Description: A 35-year-old male presented after a motor vehicle crash where his chest impacted the steering wheel. CT imaging revealed a hemopneumothorax, hemopericardium, and a comminuted sternal fracture with a large mediastinal hematoma concerning for extension to the thoracic inlet with tracheal compression. He was admitted to the trauma ICU. Serial troponin measurement, EKG, and echocardiography revealed no abnormalities. After stable cardiopulmonary monitoring and no hemodynamic changes for 48 hours, he was discharged home with recommendation to follow-up with his primary care provider.

The patient had persistent symptoms of dyspnea and chest tightness after discharge; however, it would be six months before he re-presented to our facility. Repeat imaging showed that the anterior mediastinal mass, initially interpreted as hematoma, had progressed, and was now noted to involve the sternum, encase the aortic branches, extend through the thoracic inlet to involve the thyroid, and erode through the lung and mediastinum resulting in a tracheoesophageal fistula. Subsequent biopsy revealed primary mediastinal DLBCL for which the patient is undergoing chemotherapy.

Discussion: Mediastinal hematoma after central chest injury raises suspicion for blunt cardiac injury and respiratory compromise. In the absence of early post-injury hemodynamic changes or arrhythmias, these injuries are not commonly closely followed. Here we present the unusual case of a sternal fracture and mediastinal hematoma disguising a DLBCL. We offer this case as a cautionary tale regarding a relatively rare, but crucial addition to the differential diagnosis of anterior mediastinal findings after chest injury.