Radiology, Vol 189, 737-740, Copyright © 1993 by Radiological Society of North America
Mediastinal Hodgkin disease in children: response to therapy
GD Luker and MJ Siegel
Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
PURPOSE: To determine the frequency of thymic and nodal enlargement at
computed tomography (CT) in pediatric patients with Hodgkin disease, time
to resolution of mediastinal disease, frequency of residual masses, and
ability to distinguish between thymic hyperplasia and residual fibrosis
with CT. MATERIALS AND METHODS: CT scans of 60 pediatric patients with
Hodgkin disease were reviewed. Diagnosis of a residual or recurrent mass
was based on surgical, gallium-67 scintigraphic, and clinical findings.
RESULTS: In 18 (78%) of 23 patients who underwent serial chest CT, the
mediastinum reverted to normal within a mean of 6.3 months. Of these 18
patients, four developed recurrent mediastinal widening due to thymic
hyperplasia. Five patients had residual mediastinal masses. Benign fibrosis
was confirmed in two patients at biopsy and presumed in three patients on
the basis of Ga-67 scintigraphic findings. Recurrent lymphoma was not
identified. CONCLUSION: Mediastinal masses resolve in the majority of
pediatric patients with Hodgkin disease. Residual mediastinal widening is
indicative of fibrosis, while an enlarged thymus at follow-up more likely
represents hyperplasia rather than recurrent disease.
