The objective of this study was to investigate the specific contrast-enhanced MSCT features and predominant anatomic distribution of mediastinal malignant lymphoma. Contrast-enhanced MSCT in 31 cases of mediastinal malignant lymphomas were retrospectively evaluated by analyzing the features of size, morphology, attenuation and anatomic distribution in accordance to the ATS classification of intrathoracic lymph nodes. Nine cases of Hodgkin Disease (HD) and 22 cases of Non-Hodgkin Disease (NHL) were included. The enlarged nodes were found to be homogeneous (HD 72.7%, NHL 88.9%) and partly homogeneous with necrosis (HD 27.3%, NHL 11.1%). HD involved predominantly the lymph nodes in the areas of 2R (77.8%), 3 (55.6%), 4R (88.9%), 4L (55.6%), 5 (66.7%), 6 (55.6%), 7 (66.7%) and 10R (55.6%), while NHL often involved the areas of 2R (68.2%), 3 (54.5%) 4R (59.1%), 4L (50%), 5 (54.5%), 6 (54.5%), 7 (54.5%) and 8 (50%). The following extranodal organs were involved: pericardium (19.4%), pleura (19.4%), great vessels (6.4%), lung (6.4%), chest wall (3.2%) and breast (3.2%). Mediastinal malignant lymphoma had some characteristic manifestations and predominant anatomic distribution shown on contrast-enhanced MSCT, which can provide imaging evidences for diagnosis and for determining the tumor stage.