Sandbox:Trusha
IEditor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[3]
Overview
Differential diagnosis of mediastinal mass
Wide variety of medical conditions can present as a mediastinal mass on radiological imaging.
- Mediastinal mass may cause obstruction, entrapment or infiltration of other mediastinal organs such as: Trachea, bronchi, esophagus, aorta, superior vena cava (SVC) or heart.[1]
- 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 extremities and a positive Pemberton's sign.
- Pemberton's sign: Development of suffusion, plethora, or duskiness upon elevation of the arms above the head in patient
- Superior vena cava syndrome is the most severe complication of mediastinal syndrome and a medical emergency.
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 | |||||||||
Class | Disease | Etiology | Clinical presentation | Paraclinical findings | |||||
---|---|---|---|---|---|---|---|---|---|
General symptoms | Mediastinal syndrome | ||||||||
Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | ||||
Anterior mediastinal mass | |||||||||
Tumors | Thymoma |
|
+ | + | + | Biopsy:
|
Associated condition
| ||
Fatty mass |
|
|
- | - | - | MRI:
|
Fatty mass can be:
| ||
Non-Hodgkin lymphoma |
(HIV, Hep C, HTLV-1, EBV, HHV-8, H. pylori, psittacosis, Campylobacter jejuni)
(pesticides, methotrexate, TNF inhibitors, trichloroethylene)
|
|
+/- | +/- | +/- | Excisional lymph node biopsy with immunohistochemical study
|
| ||
Teratoma |
|
Benign
Malignant |
+/- | +/- | +/- | Chest CT scan:
|
N/A | ||
Thyroid disease | Thyroid cancer |
|
|
+ | + | - | US guided biopsy: | TFT | |
Goiter |
|
+ | + | - | Radioactive iodine scan:
|
Hyperavtive gland (hyperthyroid):
Hypoactive gland (hypothyroid):
Normal functioning gland (euthyroid):
| |||
Class | Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Middle mediastinal mass | |||||||||
CVS disease | Pericardial effusion |
|
|
+ | +/- | - | Echocardiography guided pericardiocentesis:
|
Physical findings:
EKG: Echo:
| |
Aortic dissection |
|
+ | +/- | + | MRI: | TEE:
CTA:
| |||
Superior vena cava obstruction | Compression of SVC from: |
|
+ | + | ++ | Contrast-enhanced CT scan:
|
Invasive contrast venography:
| ||
Partial anomalous pulmonary venous connection |
|
|
+ | - | - | MRI with contrast:
|
Associated with
PFT:
| ||
GI disease | Esophageal achalasia |
|
+ | + | - | High resolution manometry (HRM):
|
X ray:
| ||
Esophageal cancer |
|
||||||||
Esophageal rupture | |||||||||
Hiatus hernia | |||||||||
Pulmonary disease | Hilar lymphadenopathy | ||||||||
Pneumomediastinum | |||||||||
Sarcoidosis | |||||||||
Mediastinal tumor | Mediastinal tumor | ||||||||
Mediastinal germ cell tumor | |||||||||
Infection | Mediastinitis | ||||||||
Anthrax | |||||||||
Tularemia | |||||||||
Cystic disease | Dermoid cyst | ||||||||
Bronchogenic cyst | |||||||||
Chronic
inflammatory |
Churg-Strauss syndrome | ||||||||
Class | Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Posterior mediastinal mass | |||||||||
CNS disease | Meningocele[2] | ||||||||
Neurilemmoma[2] | |||||||||
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 |
- Superior vena cava obstruction
- Partial anomalous pulmonary venous connection
- Esophageal achalasia
- Esophageal cancer
- Esophageal rupture
- Hiatus hernia
- Hilar lymphadenopathy
- Pneumomediastinum
- Sarcoidosis
- Lymphoma
- Neurilemmoma
- Non-Hodgkin lymphoma
- Teratoma
- Thymoma
References
- ↑ Zardi EM, Pipita ME, Afeltra A (October 2016). "Mediastinal syndrome: A report of three cases". Exp Ther Med. 12 (4): 2237–2240. doi:10.3892/etm.2016.3596. PMC 5038184. PMID 27698718.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMID 23225215.
- ↑ Molinari F, Bankier AA, Eisenberg RL (November 2011). "Fat-containing lesions in adult thoracic imaging". AJR Am J Roentgenol. 197 (5): W795–813. doi:10.2214/AJR.11.6932. PMID 22021525.
- ↑ Sandlund JT (2015). "Non-Hodgkin Lymphoma in Children". Curr Hematol Malig Rep. 10 (3): 237–43. doi:10.1007/s11899-015-0277-y. PMID 26174528.
- ↑ Armitage JO, Gascoyne RD, Lunning MA, Cavalli F (2017). "Non-Hodgkin lymphoma". Lancet. 390 (10091): 298–310. doi:10.1016/S0140-6736(16)32407-2. PMID 28153383.
- ↑ Yalagachin GH (June 2013). "Anterior mediastinal teratoma- a case report with review of literature". Indian J Surg. 75 (Suppl 1): 182–4. doi:10.1007/s12262-012-0569-6. PMID 24426558.
- ↑ No TH, Seol SH, Seo GW, Kim DI, Yang SY, Jeong CH, Hwang YH, Kim JY (September 2015). "Benign Mature Teratoma in Anterior Mediastinum". J Clin Med Res. 7 (9): 726–8. doi:10.14740/jocmr2270w. PMC 4522994. PMID 26251691.
- ↑ "Benign thyroid enlargement (non-toxic multinodular goiter): Overview".
- ↑ Vanneman MW, Fikry K, Quraishi SA, Schoenfeld W (August 2015). "A Young Man with a Mediastinal Mass and Sudden Cardiac Arrest". Ann Am Thorac Soc. 12 (8): 1235–9. doi:10.1513/AnnalsATS.201504-212CC. PMID 26317273.
- ↑ Salem K, Mulji A, Lonn E (November 1999). "Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade". Can J Cardiol. 15 (11): 1251–5. PMID 10579740.
- ↑ Weissmann-Brenner A, Schoen R, Divon MY (2004). "Aortic dissection in pregnancy". Obstet Gynecol. 103 (5 Pt 2): 1110–3. doi:10.1097/01.AOG.0000124984.82336.43. PMID 15121626.
- ↑ Brooke V, Goswami S, Mohanty A, Kasi PM (2012). "Aortic dissection and renal failure in a patient with severe hypothyroidism". Case Rep Med. 2012: 842562. doi:10.1155/2012/842562. PMC 3399550. PMID 22829842.
- ↑ "Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group". Ophthalmology. 98 (5 Suppl): 807–22. 1991. PMID 2062514.
- ↑ Uberoi R (2006). "Quality assurance guidelines for superior vena cava stenting in malignant disease". Cardiovasc Intervent Radiol. 29 (3): 319–22. doi:10.1007/s00270-005-0284-9. PMID 16502166.
- ↑ Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N (2008). "Superior vena cava syndrome: A medical emergency?". Int. J. Angiol. 17 (1): 43–6. PMID 22477372.
- ↑ Sears EH, Aliotta JM, Klinger JR (2012). "Partial anomalous pulmonary venous return presenting with adult-onset pulmonary hypertension". Pulm Circ. 2 (2): 250–5. doi:10.4103/2045-8932.97637. PMC 3401879. PMID 22837866.
- ↑ Broy C, Bennett S (June 2008). "Partial anomalous pulmonary venous return". Mil Med. 173 (6): 523–4. PMID 18595412.
- ↑ Gockel I, Müller M, Schumacher J (2012). "Achalasia--a disease of unknown cause that is often diagnosed too late". Dtsch Arztebl Int. 109 (12): 209–14. doi:10.3238/arztebl.2012.0209. PMC 3329145. PMID 22532812.
- ↑ Ghoshal UC, Daschakraborty SB, Singh R (2012). "Pathogenesis of achalasia cardia". World J. Gastroenterol. 18 (24): 3050–7. doi:10.3748/wjg.v18.i24.3050. PMC 3386318. PMID 22791940.
- ↑ Ates F, Vaezi MF (2015). "The Pathogenesis and Management of Achalasia: Current Status and Future Directions". Gut Liver. 9 (4): 449–63. doi:10.5009/gnl14446. PMC 4477988. PMID 26087861.
- ↑ Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ Corley DA, Kerlikowske K, Verma R, Buffler P. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003;124:47-56. PMID 12512029. See also NCI - "Esophageal Cancer (PDQ®): Prevention".
- ↑ Wong A, Fitzgerald RC. Epidemiologic risk factors for Barrett's esophagus and associated adenocarcinoma. Clin Gastroenterol Hepatol. 2005 Jan;3(1):1-10. PMID 15645398
- ↑ Ye W, Held M, Lagergren J, Engstrand L, Blot WJ, McLaughlin JK, Nyren O. Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia. J Natl Cancer Inst. 2004 Mar 3;96(5):388-96. PMID 14996860
- ↑ Nakajima S, Hattori T. Oesophageal adenocarcinoma or gastric cancer with or without eradication of Helicobacter pylori infection in chronic atrophic gastritis patients: a hypothetical opinion from a systematic review. Aliment Pharmacol Ther. 2004 Jul;20 Suppl 1:54-61. PMID 15298606
- ↑ NCI Prevention: Dietary Factors, based on Chainani-Wu N. Diet and oral, pharyngeal, and esophageal cancer. Nutr Cancer 2002;44:104-26. PMID 12734057.