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| {{Infobox_Disease |
| | #REDIRECT [[Mediastinal mass]] |
| Name = {{PAGENAME}} |
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| Image = Wide mediastinum.jpg |
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| Caption = Widened mediastinum |
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| DiseasesDB = 29459 |
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| ICD10 = |
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| ICD9 = |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = |
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| }}
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| {{SI}}
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| {{CMG}}
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| ==Overview==
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| A widened mediastinum is a [[mediastinum]] which measures greater than 8 cm in width on PA [[chest X-ray]]. A widened mediastinum can be indicative of life threatening conditions such as [[aortic dissection]] and [[esophageal rupture]].
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| ===Complete Differential Diagnosis of the Causes of ...===
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| (By organ system)
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |}
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| ==Complete Differential Diagnosis of Causes of a Widened Mediastinum==
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| In alphabetical order
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| Causes include; <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| *Acute descending necrotizing mediastinitis <ref> MKSAP 11: Medical knowledge self-assessment program. Philadelphia: American College of Physicians, 1998:966-7.</ref> <ref> Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702-8. </ref> <ref> Wheatley MJ, Stirling MC, Kirsch MM, Gago O, Orringer MB. Descending necrotizing mediastinitis: transcervical drainage is not enough. Ann Thorac Surg 1990;49:780-4.</ref> <ref> Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545-52. </ref> <ref> Alsoub H, Chacko KC. Descending necrotising mediastinitis. Postgrad Med J 1995;71:98-101.</ref>
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| *[[Anthrax]]
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| *:* This is a classic finding associated with inhalational [[anthrax]]. A widened mediastinum was found in 7 of the first 10 victims infected by anthrax (''[[Bacillus anthracis]]'') in 2001.<ref name="pmid11747719">{{cite journal |author=Jernigan JA, Stephens DS, Ashford DA, ''et al'' |title=Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States |journal=Emerging Infect. Dis. |volume=7 |issue=6 |pages=933–44 |year=2001 |pmid=11747719 |doi=}}</ref>
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| *[[Aortic dissection]]
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| *[[Bronchogenic cyst]]
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| *[[Churg-Strauss syndrome]]
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| *[[Dermoid cyst]]
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| *[[Esophageal achalasia]]
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| *[[Esophageal cancer]]
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| *[[Esophageal rupture]]
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| *[[Goitre]]
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| *[[Hiatus hernia]]
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| *[[Hilar lymphadenopathy]]
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| *[[Lymphoma]]
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| *[[Mediastinal germ cell tumor]]
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| *[[Mediastinal tumor]]
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| *[[Mediastinal mass]]
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| *[[Mediastinitis]]
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| *[[Neurilemmoma]]
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| *[[Non-Hodgkin lymphoma]]
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| *[[Partial anomalous pulmonary venous connection]]
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| *[[Pericardial effusion]]
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| *[[Pneumomediastinum]]
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| *[[Sarcoidosis]]
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| *[[Superior vena cava obstruction]]
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| *Supine AP [[chest x ray]] can yield a [[false positive]] "widened mediastinum".
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| *:* Among patients who have sustained blunt traum, AP chest radiographs are often obtained in the supine position to maintain spinal precautions. This supine position may result in fluid shifts that are in turn associated with a widening of the mediastinum. After the spine had been "cleared", some authors recommend repeating the chest X ray with the patient in the erect position which results in normalization of the mediastinal size in around 40% of patients.
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| *[[Teratoma]]
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| *[[Thymoma]]
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| *[[Thyroid cancer]]
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| *[[Tularemia]]
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| ==Diagnosis==
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| Widening of the mediastinum on the [[chest X ray]] may represent a medical emergency and the following diagnoses should be excluded immediately:
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| #[[Aortic dissection]]
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| #[[Esophageal rupture]]
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| In ruling out the presence of traumatic aortic injury in a patient, a widened mediastinum is reported as having a 53% [[sensitivity]], 59% [[specificity]] and 83% [[negative predictive value]].
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| Other less sensitive signs on the chest x ray of aortic injury include the following:
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| #Depression of the left main-stem [[bronchus]]
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| #Deviation of a naso-gastric tube to the right
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| #Apical pleural hemoatoma (cap)
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| #Disruption of the calcium ring in the aortic knob (broken-halo)
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| ===Chest X Ray===
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| Shown below is the development of a new widened mediastinum in a patient with [[aortic dissection]]:
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| <gallery>
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| Image:Wide-mediastinum-ao-dissection-3-mos-prior.jpg|Chest x ray of a patient 3 months before an [[aortic dissection]]
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| Image:Wide-mediastinum-ao-dissection-on-adm.jpg|Chest x ray of the same patient the day of admission for [[aortic dissection]] showing a new widened mediastinum
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| </gallery>
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]]
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