A 42-year-old Chinese male with asymptomatic thalassemia minor presented with a non-productive cough of several weeks duration. The patient also had intermittent soreness along the right chest wall in the area of the 7th and 8th ribs radiating from the spine to the anterior axillary line. Medical history was significant for tuberculosis in the past. A chest X-ray demonstrated a posterior mediastinal mass. Follow-up CT scan confirmed a right posterior mediastinal mass along the lateral border of the eighth thoracic vertebral body. MRI showed no evidence of invasion of the mass into the vertebral body or intravertebral foramen [Figures 1 and 2]. Very mild increased uptake of the posterior mediastinal mass was noted on positron emission tomography (PET) scanning.
Neurogenic tumor was suspected and resection of the mediastinal tumor via video-assisted thoracoscopic surgery (VATS) was planned. A 2.5 cm incision in the sixth intercostal space in the midclavicular line and a 5 mm incision in the eighth intercostal space in the midaxillary line were made. Inspection of the right hemithorax revealed extensive adhesions, which were mobilized with sharp dissection and electrocautery. After mobilizing the lung from the paravertebral region, a 2.5 cm cystic mass was encountered. The intercostal vessels supplying the mass were identified, clipped, and divided. The mass was then dissected from the chest wall along with the overlying parietal pleura. Pathological examination of the specimen revealed a 2.2 x 1.2 x 0.7 cm mass consistent with extramedullary hematopoiesis.