Unusual Cause of Suprasternal Swelling: Cervical Extension with Herniation of Mediastinal Thymus

Excerpt

A 6-y-old boy was brought with complaints of intermittent suprasternal swelling noted 5 mo back. Swelling used to appear only during valsalva maneuver (Fig. 1). Swelling was non-tender and soft with poorly defined margins. Indirect laryngoscopy did not reveal any significant abnormality. Ultrasonography of neck showed well-defined hypoechoeic structure with multiple linear hyperechoeic foci within, on left side of trachea in suprasternal region, at rest (Fig. 2a). Inferiorly, lesion was continuous with mediastinal thymus. During valsalva maneuver, there was herniation of mediastinal thymus into suprasternal region, anterior to trachea extending to both sides (Fig. 2b). Magnetic resonance imaging (MRI) confirmed extension of mediastinal thymus into suprasternal region (Fig. 2c). Since cervical extension and herniation of mediastinal thymus is not a pathological finding, patient is being followed up.

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