An 18-year-old man presented with persistent cough and mild respiratory distress for 1 month. He had experienced recurrent pulmonary infection and respiratory difficulty since 5 years of age. Physical examination showed a stony dull note on percussion and diminished breath sounds on the right side of his chest.Chest radiograph showed a large soft tissue density mass with calcification occupying the right lower hemithorax and extending into the abdominal cavity. Computed tomography (CT) of chest (Fig. 1) showed well-encapsulated heterogeneous posterior mediastinal mass extending anteriorly. It was composed of soft tissue, fluid, fat and calcific densities. It appeared to extend into the abdominal cavity, displacing the left kidney inferiorly. Magnetic resonance imaging (MRI) (Fig. 2) delineated the continuity of the diaphragm, which was inverted. The aorta and oesophagus were not involved. Surgery confirmed the mass (Fig. 3) to be limited to the thorax, inverting the diaphragm but with no intra-abdominal extension. The pathological diagnosis was mature teratoma.
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