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Imaging of the Pediatric Thymus and Thymic Disorders

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Pediatric Chest Imaging

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Imaging of the thymus can prove challenging for the radiologist. The purpose of this chapter is to provide a broad overview of the thymus, its role in normal physiology and pathologic processes. After a brief discussion of the history of the thymus, the embryology, anatomy, and histology of the thymus are reviewed. The normal appearance of the thymus using the various imaging modalities available to the radiologist is then discussed, followed by an overview of congenital thymic variants and benign pathologies involving the thymus, including thymolipoma, thymoma, and thymic rebound. The chapter concludes with a summary of thymic malignancies, with a primary focus on leukemia and lymphoma.

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References

  • Abramson SJ, Price AP (2008) Imaging of pediatric lymphomas. Radiol Clin North Am 46:313–338, ix

    Google Scholar 

  • Ackman JB, Wu CC (2011) MRI of the thymus. Am J Roentgenol 197:W15–W20

    Article  Google Scholar 

  • Adam EJ, Ignotus PI (1993) Sonography of the thymus in healthy children: frequency of visualization, size, and appearance. Am J Roentgenol 161:153–155

    Article  CAS  Google Scholar 

  • Anastasiadis K, Ratnatunga C (2007) The thymus gland: diagnosis and surgical management. Springer, Berlin

    Google Scholar 

  • Arthur R (2000) Interpretation of the paediatric chest X-ray. Paediatr Respir Rev 1:41–50

    CAS  PubMed  Google Scholar 

  • Attias D, Hodgson D, Weitzman S (2009) Primary mediastinal B-cell lymphoma in the pediatric patient: can a rational approach to therapy be based on adult studies? Pediatr Blood Cancer 52:566–570

    Article  PubMed  Google Scholar 

  • Bae YA, Lee KS (2010) Cross-sectional evaluation of thoracic lymphoma. Thorac Surg Clin 20:175–186

    Article  PubMed  Google Scholar 

  • Balcom RJ, Hakanson DO, Werner A et al (1985) Massive thymic hyperplasia in an infant with Beckwith-Wiedemann syndrome. Arch Pathol Lab Med 109:153–155

    CAS  PubMed  Google Scholar 

  • Bale PM, Sotelo-Avila C (1993) Maldescent of the thymus: 34 necropsy and 10 surgical cases, including 7 thymuses medial to the mandible. Pediatr Pathol 13:181–190

    Article  CAS  PubMed  Google Scholar 

  • Buckley RH (2006) Primary immunodeficiency or not? Making the correct diagnosis. J Allergy Clin Immunol 117:756–758

    Article  PubMed  Google Scholar 

  • Connolly LP, Connolly SA (2003) Thymic uptake of radiopharmaceuticals. Clin Nucl Med 28:648–651

    PubMed  Google Scholar 

  • Costa NS, Laor T, Donnelly LF (2010) Superior cervical extension of the thymus: a normal finding that should not be mistaken for a mass. Radiology 256:238–242

    Article  PubMed  Google Scholar 

  • Cronin CG, Swords R, Truong MT et al (2010) Clinical utility of PET/CT in lymphoma. Am J Roentgenol 194:W91–W103

    Article  Google Scholar 

  • Even-Sapir E, Israel O (2003) Gallium-67 scintigraphy: a cornerstone in functional imaging of lymphoma. Eur J Nucl Med Mol Imaging 30(Suppl 1):S65–S81

    CAS  PubMed  Google Scholar 

  • Friedmann AM, Wolfson JA, Hudson MM et al (2013) Relapse after treatment of pediatric Hodgkin lymphoma: outcome and role of surveillance after end of therapy. Pediatr Blood Cancer 60:1458–1463

    Article  PubMed  Google Scholar 

  • Gartner LA, Voorhess ML (1993) Adrenocorticotropic hormone—producing thymic carcinoid in a teenager. Cancer 71:106–111

    Article  CAS  PubMed  Google Scholar 

  • Gawande RS, Khurana A, Messing S et al (2012) Differentiation of normal thymus from anterior mediastinal lymphoma and lymphoma recurrence at pediatric PET/CT. Radiology 262:613–622

    Article  PubMed  Google Scholar 

  • Guillerman RP, Voss SD, Parker BR (2011) Leukemia and lymphoma. Radiol Clin North Am 49:767–797, vii

    Google Scholar 

  • Hegde KV, Suneetha P, Pradeep PV et al (2012) Asymptomatic thymic cyst appearing in the neck on valsalva: unusual presentation of a rare disease. J Clin Imaging Sci 2:11

    Article  PubMed Central  PubMed  Google Scholar 

  • Henkelman RM, Hardy PA, Bishop JE et al (1992) Why fat is bright in RARE and fast spin-echo imaging. J Magn Reson Imaging 2:533–540

    CAS  PubMed  Google Scholar 

  • Hodgson DC, Hudson MM, Constine LS (2007) Pediatric hodgkin lymphoma: maximizing efficacy and minimizing toxicity. Semin Radiat Oncol 17:230–242

    Article  PubMed  Google Scholar 

  • Hutchinson CB, Wang E (2011) Primary mediastinal (thymic) large B-cell lymphoma: a short review with brief discussion of mediastinal gray zone lymphoma. Arch Pathol Lab Med 135:394–398

    PubMed  Google Scholar 

  • Inaoka T, Takahashi K, Mineta M et al (2007) Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology 243:869–876

    Article  PubMed  Google Scholar 

  • Jacobs MT, Frush DP, Donnelly LF (1999) The right place at the wrong time: historical perspective of the relation of the thymus gland and pediatric radiology. Radiology 210:11–16

    Article  CAS  PubMed  Google Scholar 

  • Johnson PW, Davies AJ (2008) Primary mediastinal B-cell lymphoma. Hematol Am Soc Hematol Educ Program 2008:349–358

    Google Scholar 

  • Kaufman MR, Smith S, Rothschild MA et al (2001) Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies. Arch Otolaryngol Head Neck Surg 127:1357–1360

    Article  CAS  PubMed  Google Scholar 

  • Kelly KM, Hodgson D, Appel B et al (2013) Children’s Oncology Group’s 2013 blueprint for research: Hodgkin lymphoma. Pediatr Blood Cancer 60:972–978

    Article  PubMed  Google Scholar 

  • Kim OH, Kim WS, Kim MJ et al (2000) US in the diagnosis of pediatric chest diseases. Radiographics 20:653–671

    Article  CAS  PubMed  Google Scholar 

  • Kluge R, Kurch L, Montravers F et al (2013) FDG PET/CT in children and adolescents with lymphoma. Pediatr Radiol 43:406–417

    Article  PubMed  Google Scholar 

  • Kontny HU, Sleasman JW, Kingma DW et al (1997) Multilocular thymic cysts in children with human immunodeficiency virus infection: clinical and pathologic aspects. J Pediatr 131:264–270

    Article  CAS  PubMed  Google Scholar 

  • MacDonald K, Mackenzie S (2009) What happens to the thymus in children who have undergone a median sternotomy? Pediatr Radiol 39:616–621

    Article  PubMed  Google Scholar 

  • Martelli M, Ferreri AJ, Johnson P (2008) Primary mediastinal large B-cell lymphoma. Crit Rev Oncol Hematol 68:256–263

    Article  PubMed  Google Scholar 

  • Mizuno T, Hashimoto T, Masaoka A et al (1997) Thymic follicular hyperplasia manifested as an anterior mediastinal mass. Surg Today 27:275–277

    Article  CAS  PubMed  Google Scholar 

  • Molina PL, Siegel MJ, Glazer HS (1990) Thymic masses on MR imaging. Am J Roentgenol 155:495–500

    Article  CAS  Google Scholar 

  • Mong A, Epelman M, Darge K (2012) Ultrasound of the pediatric chest. Pediatr Radiol 42:1287–1297

    Article  PubMed  Google Scholar 

  • Mortelmans A, Hermans R (2005) Thymopharyngeal duct cyst. JBR-BTR 88:99

    CAS  PubMed  Google Scholar 

  • Nasseri F, Eftekhari F (2010) Clinical and radiologic review of the normal and abnormal thymus: pearls and pitfalls. Radiographics 30:413–428

    Article  PubMed  Google Scholar 

  • Newman B (2011) Ultrasound body applications in children. Pediatr Radiol 41(Suppl 2):555–561

    Article  PubMed  Google Scholar 

  • Park CM, Goo JM, Lee HJ et al (2009) Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics 29:55–71

    Article  PubMed  Google Scholar 

  • Petroze R, McGahren ED: Pediatric chest II (2012) Benign tumors and cysts. Surg Clin North Am 92:645–658, ix

    Google Scholar 

  • Rathore N, Eissa HM, Margolin JF et al (2012) Pediatric Hodgkin lymphoma: are we over-scanning our patients? Pediatr Hematol Oncol 29:415–423

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Restrepo CS, Pandit M, Rojas IC et al (2005) Imaging findings of expansile lesions of the thymus. Curr Probl Diagn Radiol 34:22–34

    Article  PubMed  Google Scholar 

  • Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL (1999) Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975-1995. In: Bunin GR (ed) National Cancer Institute SEER Program. No. 99-4649, Bethesda, MD

    Google Scholar 

  • Safieddine N, Keshavjee S (2011) Anatomy of the thymus gland. Thorac Surg Clin 21:191–195, viii

    Google Scholar 

  • Sharma P, Singhal A, Kumar A et al (2013) Evaluation of thymic tumors with 18F-FDG PET-CT: a pictorial review. Acta Radiol 54:14–21

    Article  PubMed  Google Scholar 

  • Shepherd SF, A’Hern RP, Pinkerton CR (1995) Childhood T-cell lymphoblastic lymphoma—does early resolution of mediastinal mass predict for final outcome? The United Kingdom Children’s Cancer Study Group (UKCCSG). Br J Cancer 72:752–756

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Siegel MJ, Glazer HS, Wiener JI et al (1989) Normal and abnormal thymus in childhood: MR imaging. Radiology 172:367–371

    Article  CAS  PubMed  Google Scholar 

  • Sklair-Levy M, Agid R, Sella T et al (2000) Age-related changes in CT attenuation of the thymus in children. Pediatr Radiol 30:566–569

    Article  CAS  PubMed  Google Scholar 

  • Tateishi U, Muller NL, Johkoh T et al (2004) Primary mediastinal lymphoma: characteristic features of the various histological subtypes on CT. J Comput Assist Tomogr 28:782–789

    Article  PubMed  Google Scholar 

  • Termuhlen AM, Smith LM, Perkins SL et al (2013) Disseminated lymphoblastic lymphoma in children and adolescents: results of the COG A5971 trial: a report from the children’s oncology group. Br J Haematol 162:792–801

    Article  CAS  PubMed  Google Scholar 

  • Tunkel DE, Erozan YS, Weir EG (2001) Ectopic cervical thymic tissue: diagnosis by fine needle aspiration. Arch Pathol Lab Med 125:278–281

    CAS  PubMed  Google Scholar 

  • Varga I, Pospisilova V, Jablonska-Mestanova V et al (2011) The thymus: picture review of human thymus prenatal development. Bratisl Lek Listy 112:368–376

    CAS  PubMed  Google Scholar 

  • Voss SD, Chen L, Constine LS, Chauvenet A, Fitzgerald TJ, Kaste SC, Slovis T, and Schwartz CL (2012) Surveillance computed tomography imaging and detection of relapse in intermediate- and advanced-stage pediatric Hodgkin's lymphoma: a report from the Children's Oncology Group. J Clin Oncol 30(21):2635–2640

    Google Scholar 

  • Voss SD (2013) Surveillance imaging in pediatric hodgkin lymphoma. Curr Hematol Malig Rep 8:218–225

    Google Scholar 

  • Yaris N, Nas Y, Cobanoglu U et al (2006) Thymic carcinoma in children. Pediatr Blood Cancer 47:224–227

    Article  PubMed  Google Scholar 

  • Yin EZ, Frush DP, Donnelly LF et al (2001) Primary immunodeficiency disorders in pediatric patients: clinical features and imaging findings. Am J Roentgenol 176:1541–1552

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Cassandra M. Sams & Stephan D. Voss

Authors
  1. Cassandra M. Sams
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  2. Stephan D. Voss
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Correspondence to Stephan D. Voss .

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Editors and Affiliations

  1. Department of Pediatric Radiology, Vall d´Hebron Children´s University Hospital, Barcelona, Spain

    Pilar Garcia-Peña

  2. Department of Pediatric Radiology, Baylor College of Medicine, Houston, Texas, USA

    R. Paul Guillerman

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© 2014 Springer-Verlag Berlin Heidelberg

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Sams, C.M., Voss, S.D. (2014). Imaging of the Pediatric Thymus and Thymic Disorders. In: Garcia-Peña, P., Guillerman, R. (eds) Pediatric Chest Imaging. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2013_955

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  • DOI: https://doi.org/10.1007/174_2013_955

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37336-7

  • Online ISBN: 978-3-642-37337-4

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