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I{{CMG}} {{AE}} {{Trusha}}
{{CMG}} {{AE}} {{Trusha}}


==Overview==
==new==


==Differential diagnosis of mediastinal mass==
Wide variety of medical conditions can present as a mediastinal mass on [[Radiology|radiological imaging]].
* Mediastinal mass may cause [[obstruction]], [[entrapment]] or [[Infiltration (medical)|infiltration]] of other [[Mediastinum|mediastinal organs]] such as: [[Trachea]], [[Bronchus|bronchi]], [[esophagus]], [[aorta]], [[SVC|superior vena cava (SVC)]] or [[heart]].<ref name="pmid27698718">{{cite journal |vauthors=Zardi EM, Pipita ME, Afeltra A |title=Mediastinal syndrome: A report of three cases |journal=Exp Ther Med |volume=12 |issue=4 |pages=2237–2240 |date=October 2016 |pmid=27698718 |pmc=5038184 |doi=10.3892/etm.2016.3596 |url=}}</ref>
* Disorder caused by any kind of [[mediastinal mass]] is collectively known as: [[Mediastinal syndromes]]
* '''Mediastinal syndrome''' includes:
** Compression of the [[trachea]]: [[Dyspnea]] and [[respiratory insufficiency]].
** Compression of the [[esophagus]]: [[Dysphagia]].
** Compression of [[SVC]] causes [[superior vena cava syndrome]]: [[Vein]] distention, [[edema]] of the face or [[Upper limb|upper extremities]] and a positive [[Pemberton's sign]].
*** [[Superior vena cava syndrome]] is the most severe [[Complication (medicine)|complication]] of [[mediastinal syndrome]] and a [[medical emergency]].


{|
| colspan="10" |'''<small>ABBREVIATIONS''': '''N/A''': Not available, '''SOB''': Shortness of breath, '''M/C''': Most common, '''RI''': Respiratory insufficiency, '''NM''': Neuromuscular system, '''SVCS''': Superior vena cava syndrome, '''SLE''': Systemic lupus erythematosus disease, '''T3:''' Triiodothyronine, '''T4:''' Thyroxine, '''TSH:''' Thyroid stimulating hormone, '''TFT:''' Thyroid function test</small><small><nowiki/></small><small><nowiki/></small>
|-
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Class'''
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical presentation
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''General symptoms'''
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mediastinal syndrome
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dyspnea/
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |SVCS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
! colspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anterior mediastinal mass
|-
| rowspan="4" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |'''Tumors'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thymoma|'''Thymoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Human foamy virus]]
* [[Epstein-Barr virus]]
* Human T-cell lymphotropic virus
* [[MEN 1 syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
* [[wheezing]]
* [[Chest pain]]
* [[Muscle weakness]] ([[Myasthenia gravis|MG]])
* [[Anemia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]:
* [[Epithelium|Epithelial cells]]
* [[Lymphoblasts|Immature lymphocytes]]
* Immature T cells
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Associated condition'''
* NM
** [[Myasthenia gravis]]
** [[Neuromyotonia]]
** [[Rippling muscle disease]]
** [[Polymyositis and dermatomyositis|Polymyositis/dermatomyositis]]
** [[Encephalitis]] (limbic, cortical and brain stem)
** [[Intestinal pseudoobstruction]]
* Hematological
** [[Anemia]]: [[pure red cell aplasia]], [[pernicious anemia]], [[hemolytic anemia]], [[aplastic anemia]]
** Other isolated [[Cytopenia|cytopenias]]: [[eosinophils]], [[basophils]] [[neutrophils]]
** Immunodeficiencies: [[Hypogammaglobulinaemia|hypogammaglobulinemia]]/- T-cell deficiencies [[Good syndrome|(Good syndrome)]]
* Dermatological
** [[Pemphigus]] ([[Pemphigus foliaceus|foliaceus]] or [[Paraneoplastic syndrome|paraneoplastic]])
** [[Lichen planus]]
** [[Alopecia areata]]
* Endocrine
** [[Addison's disease|Addison disease]]
** [[Graves' disease|Grave's disease]]
** [[Cushing's disease]]
* Hepato-renal
** [[Glomerulonephritis]]
** [[Autoimmune hepatitis]]
* Systemic Autoimmune Diseases
** [[SLE]]
** [[Sjögren's syndrome]]
** [[Systemic sclerosis]]
** [[Graft-versus-host disease]]


|-
{| align="right"
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Fatty mass'''
|
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid22021525">{{cite journal |vauthors=Molinari F, Bankier AA, Eisenberg RL |title=Fat-containing lesions in adult thoracic imaging |journal=AJR Am J Roentgenol |volume=197 |issue=5 |pages=W795–813 |date=November 2011 |pmid=22021525 |doi=10.2214/AJR.11.6932 |url=}}</ref>
[[Image:Squamous cell mircopathology2.jpeg|x200px|thumb| Micropathology: Squamous cell carcinoma of the lung. H&E stain, By Nephron [https://commons.wikimedia.org/wiki/File%3ALung_squamous_carcinoma_--_high_mag.jpg Wikimedia Commons]]]
| style="background: #F5F5F5; padding: 5px;" |
|}
* Steroid use
{| align="right"
* Cushing's syndrome
|
* Obeses
[[Image:Bronchial cancer.jpeg|x200px|thumb|Gross pathology: Bronchial squamous lung cell cancer By John Hayman [Public domain], (Image source: [https://commons.wikimedia.org/wiki/File%3ACa_bronchus.jpg Wikimedia Commons])]]
| style="background: #F5F5F5; padding: 5px;" |
|}
* Mostly asymptomatic
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |MRI:
* Well-defined encapsulated mas
* Extensive fat content
* Small amounts of solid areas
* Fibrous septa
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Fatty mass can be:
* Lipoma
* Liposarcoma
* Thymolipoma
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Non-Hodgkin lymphoma|'''Non-Hodgkin lymphoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid26174528">{{cite journal| author=Sandlund JT| title=Non-Hodgkin Lymphoma in Children. | journal=Curr Hematol Malig Rep | year= 2015 | volume= 10 | issue= 3 | pages= 237-43 | pmid=26174528 | doi=10.1007/s11899-015-0277-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26174528  }}</ref><ref name="pmid28153383">{{cite journal| author=Armitage JO, Gascoyne RD, Lunning MA, Cavalli F| title=Non-Hodgkin lymphoma. | journal=Lancet | year= 2017 | volume= 390 | issue= 10091 | pages= 298-310 | pmid=28153383 | doi=10.1016/S0140-6736(16)32407-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153383  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Age (above 60 years)
* Caucasians > African and Asian Americans
* Positive family history of first degree relative
* B-cell activating autoimmune disorders
* Radiation exposure
* Infections
(HIV, Hep C, HTLV-1, EBV, HHV-8, H. pylori, psittacosis, Campylobacter jejuni)
* Previous cancer treatment
* Exposure to chemicals and drugs
(pesticides, methotrexate, TNF inhibitors, trichloroethylene)
* Cigarette smoking for ≥ 40 years
* BMI ≥30 kg/m2
* Diet
* Hair dyes
* Breast implants


*
{|
| style="background: #F5F5F5; padding: 5px;" |
* Painless [[lymphadenopathy]]
* [[Fever]]
* [[Weight loss]] and [[Anorexia (symptom)|anorexia]]
* [[Night sweats]]
* Constant [[Fatigue (physical)|fatigue]]
* [[Pruritis|Itchy skin]]
* [[Cough]]
* [[Shortness of breath]]
* [[Abdominal pain]] or swelling
* [[Constipation]]
* [[Nausea]]
* [[Vomiting]]
* [[Headache]]
* Personality changes
* [[Seizures]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Excisional lymph node biopsy with immunohistochemical study
* CD 20+ cells
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Anemia|Anemia:]]
**Involvement of [[bone marrow]]
**[[Autoimmune hemolytic anemia|Autoimmune hemolysis]] and [[bleeding]]
 
* [[Thrombocytopenia]], [[leukopenia]], or [[pancytopenia]]
* [[Lymphocytosis]] with [[malignant]] cell
* [[Thrombocytosis]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma|'''Teratoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid24426558">{{cite journal |vauthors=Yalagachin GH |title=Anterior mediastinal teratoma- a case report with review of literature |journal=Indian J Surg |volume=75 |issue=Suppl 1 |pages=182–4 |date=June 2013 |pmid=24426558 |doi=10.1007/s12262-012-0569-6 |url=}}</ref><ref name="pmid26251691">{{cite journal |vauthors=No TH, Seol SH, Seo GW, Kim DI, Yang SY, Jeong CH, Hwang YH, Kim JY |title=Benign Mature Teratoma in Anterior Mediastinum |journal=J Clin Med Res |volume=7 |issue=9 |pages=726–8 |date=September 2015 |pmid=26251691 |pmc=4522994 |doi=10.14740/jocmr2270w |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Benign equal in men and women
* Malignant more common in men
* Pediatric population higher risk
| style="background: #F5F5F5; padding: 5px;" |Benign
* Asymptomatic
Malignant
* [[Cough]]
* [[Chest pain]]
* [[Trichoptysis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |Chest CT scan:
* Location
* Metastasis
* Intrinsic structure
* Soft tissue
* Fat
* Calcification
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |N/A
|-
| rowspan="2" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |'''Thyroid disease'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Thyroid cancer]]<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
* Hx of [[goiter]]
* Family Hx of thyroid disease
* Female gender
* Asian race
* [[Radiation exposure]]
* [[Multiple endocrine neoplasia|MEN syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Lump]] in the neck
* [[Dysphonia]]
* [[Lymphadenopathy]]
* [[Cough]]
* [[Sore throat]]
* [[Neck pain]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |US guided biopsy:
* [[Papillary thyroid cancer]]
* [[Follicular thyroid cancer]]
* [[Medullary thyroid cancer]]
* [[Anaplastic thyroid cancer]]
* [[Primary thyroid lymphoma|Lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Thyroid function tests|TFT]]
* Elevated [[Triiodothyronine|T3]]
* Elevated [[Thyroxine|T4]]
* Low [[Thyroid-stimulating hormone|TSH]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Goitre|'''Goiter''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="urlBenign thyroid enlargement (non-toxic multinodular goiter): Overview">{{cite web |url=http://endocrinediseases.org/thyroid/goiter.shtml |title=Benign thyroid enlargement (non-toxic multinodular goiter): Overview |format= |work= |accessdate=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Iodine]] deficiency
* Female gender
* Age over 50 years
* Personal or family history
* Certain medications
** [[Immunosuppressant|Immunosuppressants]]
** [[Antiretroviral|Antiretrovirals]]
** [[Amiodarone]]
** [[Lithium]]
* [[Radiation]]
| style="background: #F5F5F5; padding: 5px;" |
* A visible swelling at the base of your neck
* Tight feeling in throat
* [[Cough]]
* [[Hoarseness]]
* [[Fatigue]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |Radioactive iodine scan:
* Nodules
* Size
* Function of the gland: ↑ or ↓
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Hyperavtive gland (hyperthyroid):
* Grave's disease
Hypoactive gland (hypothyroid):
* Hashimoto thyroiditis
Normal functioning gland (euthyroid):
* Benign thyroid enlargement (non toxic multinodular goiter) 
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Class'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dyspnea/
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |SVCS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
! colspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Middle mediastinal mass
|-
| rowspan="4" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |'''CVS disease'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pericardial effusion|'''Pericardial effusion''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid26317273">{{cite journal |vauthors=Vanneman MW, Fikry K, Quraishi SA, Schoenfeld W |title=A Young Man with a Mediastinal Mass and Sudden Cardiac Arrest |journal=Ann Am Thorac Soc |volume=12 |issue=8 |pages=1235–9 |date=August 2015 |pmid=26317273 |doi=10.1513/AnnalsATS.201504-212CC |url=}}</ref><ref name="pmid10579740">{{cite journal |vauthors=Salem K, Mulji A, Lonn E |title=Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade |journal=Can J Cardiol |volume=15 |issue=11 |pages=1251–5 |date=November 1999 |pmid=10579740 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Acute myocardial infarction]]
* [[Aortic dissection]]
* [[Aortic rupture]]
* [[Myocardial rupture]]
* [[Ventricular aneurysm|Rupture of ventricular aneurysm]]
* [[Uremic pericarditis]]
* [[Rheumatic fever|Rheumatic pericarditis]]
* [[Tuberculous pericarditis]]
* [[Uremic pericarditis]]
* [[Pericarditis|Viral pericarditis]]
* [[Dressler's syndrome]]
* [[Cardiac catheterization]]
* [[Cardiomyopathy]]
* [[Chemotherapy]]
* [[Chest trauma]]
* [[Collagen vascular disease]]
* [[Congestive heart failure]]
* [[Neoplasm]]
* [[Postpericardiotomy syndrome]]
* [[Radiation injury|Postirradiation]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
* The positional change affecting the [[chest pain]]
* [[Orthopnea]]
* [[Fever]]
* symptoms of [[infection]], [[injury]] or systemic disease causing the [[Pericardial effusion|effusion]]
 
*
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography]]  guided [[pericardiocentesis]]:
* [[Therapy|Therapeutic]]
* [[Diagnostic]]
* [[Pericarditis|pericardial disease]]
* [[Hemodynamic]] parameters
* Volume
* Effusion content
([[blood]]/[[exudate]]/[[transudate]])
* [[Microbial culture]]
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Physical findings:
* [[Pulsus paradoxus]]
* [[Hypotension]] in [[cardiac tamponade]]
* [[Jugular venous distension]] with a prominent Y descent
* [[Kussmaul's sign]]
EKG:
* [[Electrical alternans]]
Echo:
* Presence of effusion
* Reversal of [[Right atrium|RA]] and [[Right ventricle|RV]] [[Diastole|diastolic]] trans-mural pressures
* [[Heart|Cardiac chamber]] indentation or [[Collapse (medical)|collapse]]
* [[Respiratory]] variation of [[Heart valve|atrioventricular valves]] increased.
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Aortic dissection]]'''
'''<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid15121626">{{cite journal| author=Weissmann-Brenner A, Schoen R, Divon MY| title=Aortic dissection in pregnancy. | journal=Obstet Gynecol | year= 2004 | volume= 103 | issue= 5 Pt 2 | pages= 1110-3 | pmid=15121626 | doi=10.1097/01.AOG.0000124984.82336.43 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15121626  }}</ref><ref name="pmid22829842">{{cite journal| author=Brooke V, Goswami S, Mohanty A, Kasi PM| title=Aortic dissection and renal failure in a patient with severe hypothyroidism. | journal=Case Rep Med | year= 2012 | volume= 2012 | issue=  | pages= 842562 | pmid=22829842 | doi=10.1155/2012/842562 | pmc=PMC3399550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22829842  }}</ref><ref name="pmid2062514">{{cite journal| author=| title=Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group. | journal=Ophthalmology | year= 1991 | volume= 98 | issue= 5 Suppl | pages= 807-22 | pmid=2062514 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2062514  }}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
*[[Atherosclerosis]]
*[[Chest trauma]]
 
* [[Chronic hypertension]]
* [[Iatrogenic|Complication of cardiac procedures]]
 
*[[Connective tissue disorders]]
*[[Vasculitis]]
*Advanced age
*[[Smoking]]
*[[Lipoprotein disorders|Dyslipidaemia]]
*[[Cocaine]]
*[[Connective tissue disease|Connective tissue disorders]]
 
| style="background: #F5F5F5; padding: 5px;" |
* Severe acute [[chest pain]]
* [[Back pain]]
* Pain radiating to neck, throat, jaw, and/or unilateral face
 
* [[Abdominal pain]]
* [[Claudication]]
* [[Hemoptysis]]
* [[Horner syndrome]]
* [[Oliguria]]/ [[Anuria]]
* [[Paraplegia]], [[paralysis]]
* [[Hoarseness]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Magnetic resonance imaging|MRI]]:
* Location of the [[Intima|intimal]] tear
* Involvement of branches of [[aorta]]
* Other vascular pathology
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Transesophageal echocardiography (TEE)|TEE]]:
* Identify true and [[False lumen|false lumens]]
* [[Intima|Intimal]] flap
* [[Thrombosis]] in the [[false lumen]]
* [[Pericardial effusion]]
* [[AI|Aortic regurgitation]]
* [[Proximal]] [[Coronary artery|coronaries]]
[[CT angiography|CTA]]:
* Beak sign: An [[acute]] angle between the dissection flap and the [[Artery|arterial]] wall
* [[Aortic]] cobwebs: Fibroelastic bands
* Size: [[False lumen]] larger than the true [[lumen]]
* Displaced [[Intima|intimal]] [[calcification]]: True lumen
 
*
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Superior vena cava obstruction]]<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |Compression of [[SVC]] from:
* [[Aortic aneurysm]]
* [[Bronchogenic carcinoma]]
* [[Breast cancer]]
* [[Cystic hygroma]]
* [[Goiter]]
* [[Histoplasmosis]]
* [[Central venous catheter|Indwelling catheter]]
* [[Lung cancer]]
* [[Lymphoma]]
* [[Non Hodgkin's lymphoma]]
* [[Small cell lung cancer]]
* [[Thymoma]]
* [[Tuberculosis]]


| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
* [[Hoarseness]]
* [[Chest pain]]
* Problems [[swallowing]] and/or talking
* [[Hemoptysis]]
* [[Headache]]
* [[Lightheadedness]]
* [[Decreased alertness]]
* [[Dizziness]]
* [[Fainting]]
* Sensation of [[head]] or [[ear]] "fullness"
* Vision changes
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |CT scan:
* Location and severity of the [[obstruction]]
* Superimposed [[thrombosis]]
* Mediastinal mass or [[lymphadenopathy]]
* Collateral vessels and associated lung masses
*
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Invasive contrast venography:
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Partial anomalous pulmonary venous connection]]<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| rowspan="4" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |GI disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal achalasia|'''Esophageal achalasia''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal cancer|'''Esophageal cancer''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal rupture|'''Esophageal rupture''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hiatus hernia|'''Hiatus hernia''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| rowspan="3" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |Pulmonary disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hilar lymphadenopathy|'''Hilar lymphadenopathy''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pneumomediastinum|'''Pneumomediastinum''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis|'''Sarcoidosis''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| rowspan="2" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |Mediastinal tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mediastinal tumor|'''Mediastinal tumor''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Mediastinal germ cell tumor]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| rowspan="3" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |Infection
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mediastinitis|'''Mediastinitis''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anthrax|'''Anthrax''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tularemia|'''Tularemia''']]
|
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| rowspan="2" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |Cystic disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dermoid cyst|'''Dermoid cyst''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Bronchogenic cyst]]'''
'''<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #4479BA; color: #FFFFFF; padding: 5px;" |Chronic
inflammatory
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Churg-Strauss syndrome|'''Churg-Strauss syndrome''']]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Class'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dyspnea/
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Dysphagia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |SVCS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
! colspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Posterior mediastinal mass
|-
| rowspan="2" style="background: #4479BA; color: #FFFFFF; padding: 5px;" |CNS disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Meningocele]]<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Neurilemmoma]]<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| colspan="10" |'''<small>ABBREVIATIONS''': '''N/A''': Not available, '''SOB''': Shortness of breath, '''M/C''': Most common, '''RI''': Respiratory insufficiency, '''NM''': Neuromuscular system, '''SVCS''': Superior vena cava syndrome, '''SLE''': Systemic lupus erythematosus disease, '''T3:''' Triiodothyronine, '''T4:''' Thyroxine, '''TSH:''' Thyroid stimulating hormone, '''TFT:''' Thyroid function test</small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small>
|-
|}


# [[Superior vena cava obstruction]]
# [[Superior vena cava obstruction]]
Line 659: Line 47:




[[File: name|x300px|thumb| CT scan showing a smooth anterior mediastinal mass, with a mixed internal density of containing both enhancing soft tissue and cystic areas. The outline of the mass is relatively well defined. No lymphadenopathy, pleural effusion or infiltration. Case courtesy of Dr. Abdallah Al Khateeb
[[File:Mediastinal lymohangioma GIF.gif|x200px|thumb| CT scan shows cystic mass which was located on the posterior to the lower esophagus later diagnosed as thoracic duct lymphangioma. [https://doi.org/10.5090/kjtcs.2014.47.4.423 Source:Case courtesy of Jin San Bok et al, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital]]]
(Picture courtesy: [https://radiopaedia.org/cases/43403 Radiopedia])]]
 
[[File:Posterior-mediastinal-schwannoma.gif|x200px|thumb| CT scan showing a soft tissue density lesion within the left posterior mediastinum, in a paravertebral location. The lesion is closely related to the left neural exit foramen, but there is no definite extension into the spinal canal. The lesion does extend into the intercostal space.
Case courtesy of Dr Paul Leong
(Picture courtesy:[https://radiopaedia.org/cases/26625 Radiopedia])]]
 
 
 
 
__NOTOC__
{{SI}}
{{CMG}}; {{AE}} {{Trusha}}, {{AM}}
 
{{SK}} Mediastinal enlargement; mass in the mediastinum
 
==Overview==
 
The [[mediastinum]] is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. Since it is the central compartment of the thoracic cavity, and it contains a lot of important structures, it is the site of involvement of various tumors.
 
==Causes==
 
 


==Initial Evaluation==
{{familytree/start}}
{{Family tree |border=2|boxstyle=background: WhiteSmoke;| | | | | A01 | | | | |A01=<div style="float: left; text-align: center; height: 1.25em; width: 25em; padding: 1em;">'''Mediastinal Mass'''</div>}}
{{familytree | | | | | |!| | | | | | | | }}
{{familytree | | | | | B01 | | | |B01=<div style="float: left; text-align: left; line-height: 150%; padding: 1em; "> '''Workups'''
----
❑ CT chest with contrast <br> ❑ Serum beta-HCG, AFP, if appropriate <br> ❑ CBC, platelets <br> ❑ PET-CT scan (optional) <br> ❑ Pulmonary function tests if clinically indicated <br> ❑ MRI chest if clinically indicated
</div>}}
{{familytree | |,|-|-|-|^|-|-|-|.| | | | | | | }}
{{familytree | C01 | | | | | | C02 | | | |C01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Likely''' </div> |C02= <div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;">  '''Thymic Tumor Unlikely''' </div>}}
{{familytree | |!| | | | | | | |!| | | | | }}


[[File: name|x300px|thumb| CT scan showing excessive fatty tissue deposition within the posterior mediastinum with anterior displacement of the esophagus. Case courtesy of Dr. Ahmed Abdrabou (Picture courtesy: [https://radiopaedia.org/cases/50447Radiopedia])]]
{{familytree | D01 | | | | | | D02 | | | |D01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Consider [[Thymoma surgery|surgery]]</div>|D02=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Disease-specific management</div>}}


{{familytree/start}}




==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 20:48, 4 March 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

new

Micropathology: Squamous cell carcinoma of the lung. H&E stain, By Nephron Wikimedia Commons
Gross pathology: Bronchial squamous lung cell cancer By John Hayman [Public domain], (Image source: Wikimedia Commons)
  1. Superior vena cava obstruction
  2. Partial anomalous pulmonary venous connection
  3. Esophageal achalasia
  4. Esophageal cancer
  5. Esophageal rupture
  6. Hiatus hernia
  7. Hilar lymphadenopathy
  8. Pneumomediastinum
  9. Sarcoidosis
  10. Lymphoma
  11. Neurilemmoma
  12. Non-Hodgkin lymphoma
  13. Teratoma
  14. Thymoma
  1. Thyroid cancer
  2. Goitre
  3. Mediastinal germ cell tumor,
  4. Mediastinal tumor,
  5. Mediastinitis
  1. Churg-Strauss syndrome
  2. Bronchogenic cyst,
  3. Dermoid cyst
  4. Anthrax:
  5. Tularemia
CT scan shows cystic mass which was located on the posterior to the lower esophagus later diagnosed as thoracic duct lymphangioma. Source:Case courtesy of Jin San Bok et al, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital


CT scan showing a soft tissue density lesion within the left posterior mediastinum, in a paravertebral location. The lesion is closely related to the left neural exit foramen, but there is no definite extension into the spinal canal. The lesion does extend into the intercostal space. Case courtesy of Dr Paul Leong (Picture courtesy:Radiopedia)



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[4], Amr Marawan, M.D. [5]

Synonyms and keywords: Mediastinal enlargement; mass in the mediastinum

Overview

The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. Since it is the central compartment of the thoracic cavity, and it contains a lot of important structures, it is the site of involvement of various tumors.

Causes

Initial Evaluation

 
 
 
 
Mediastinal Mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Workups

❑ CT chest with contrast
❑ Serum beta-HCG, AFP, if appropriate
❑ CBC, platelets
❑ PET-CT scan (optional)
❑ Pulmonary function tests if clinically indicated
❑ MRI chest if clinically indicated

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thymic Tumor Likely
 
 
 
 
 
Thymic Tumor Unlikely
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider surgery
 
 
 
 
 
Disease-specific management
 
 
 

References

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