The most likely diagnosis in this patient with back pain is, well, in the chest you see a paratrachial mass that's low density.
You can go through a differential of nodes, you can even think about lymphoma, you can think about sub-sternal thyroid.
But then you get scans in the abdomen and you see large bulky adenopathy, but the adenopathy, which displaces the aorta, is really of low density.
Lymphoma, unless it's treated, does not look cystic, so that's not a good answer.
This does not look like a retroperitonegal bleed, and plus we have a findings that involve chest and a retroperitoneum.
Extra-medially amount of polices is typically vascular and solid, and not this bulky.
And again, we have chest and abdomen involvement here.
And this is just a nice example of a patient, initial presentation of semenoma, where there's extensive cystic nodes present, as well as metastinal disease, and these are more common in younger men.
