Correct!
5. All of the above
All are causes of anterior mediastinal masses and account for the 4 T’s many of us learned as medical students with terrible added before lymphoma (3). However, this abnormality appears different. It has more the appearance of diffuse pleural thickening. Because the abnormality extends retrosternally across the mediastinum from pleural surface to pleural surface, some authors have referred to this as “bridging” (4). In a series of patients with retroperitoneal fibrosis, Uibu et al. (5) reported 3 of 22 subjects with retroperitoneal fibrosis secondary to asbestos exposure, had exceptionally large pleural masses that were located anteriorly in the pleural space and continued into the anterior mediastinum (Figure 3).
Figure 3. Pleural masses (arrows) in patients with retroperitoneal fibrosis from reference 5. Panel A: a 55 year old former pipefitter. Panel B: a 62 year old stroreman who had used asbestos gloves and sealing tapes and done some pipe insulation. Panel C: a 76 year old construction cleaner.
These masses appear similar to our patient’s. In Uibu’s series of patients with retroperitoneal fibrosis not secondary to asbestos exposure, none had similar patterns of pleural thickening (5).
Retroperitoneal fibrosis has causes similar to pleural fibrosis including malignant disease, radiation, abdominal surgery, hematomas, and infection. However, methylsergide use and asbestos exposure for > 10 yr (RR 8.84) appear to be frequently common (6,7).
References