Fig. 1

Preoperative chest images (a) Cross –sectional CT image shows enlargement of lymph nodes (arrow) on the right carotid artery. b CT image reveals soft tissue density shadow in the mediastinum (arrow) in place of adipose tissue, with mild reinforcement (CT value = 32). c Thoracic sagittal section CT image shows diffuse reduction of the intensity in C7, T1-T8 (the arrow points to T8), T10 bodies, and bone absorption is indicated. d Thoracic coronal sectionCT image shows pericardial effusion and pleural effusion. e PET-CT image shows slightly increased FDG uptake in the region of neck and mediastinum