Mediastinal mass differential diagnosis
Mediastinal mass Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]
Overview
The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. It is the central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, esophagus, trachea, thymus, and lymph nodes of the central chest. A wide variety of diseases involving mediastinal structures may present as a mediastinal mass or widening of the mediastinum on imaging studies. Mediastinal widening is diagnosed by the mediastinum measuring greater than 8 cm in width on PA chest x-ray. The mediastinal mass may present with symptoms or even without any symptoms. Mediastinal mass may cause a variety of symptoms by the mass pressing against surrounding mediastinal structures, collectively known as mediastinal syndrome. Mediastinal may can be differentiated depending on their location in mediastinal cavity into: Anterior mediastinal mass, middle mediastinal mass, or posterior mediastinal mass. Mediastinal mass may also be differentiated according to the content of the mass such as: cystic, fatty or solid (tumor).
Mediastinal Mass Differential Diagnosis
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.
- Symptoms caused by any kind of mediastinal mass is collectively known as: Mediastinal syndrome
- Mediastinal syndrome includes:
- Symptoms caused by compression of the trachea: Dyspnea and respiratory insufficiency.
- Symptoms caused by compression of the esophagus: Dysphagia.
- Symptoms caused by 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, MRI: Magnetic resonance imaging, CNS: Central nervous system, CSF: Cerebrospinal fluid, FNA: Fine needle aspiration, CBC: Complete blood count, COPD: Chronic obstructive pulmonary disease, AIDS: Acquired immune deficiency syndrome, HIV: Human immunodeficiency virus, Hep C: Hepatitis C virus, HTLV-1: human T-lymphotropic virus, EBV: Epstein Barr virus, HHV-8: Human herpes virus-8 | ||||||||
Disease | Causes/risk factors | Clinical presentation | Paraclinical findings | |||||
---|---|---|---|---|---|---|---|---|
General symptoms | Mediastinal syndrome | |||||||
Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | |||
Anterior mediastinal mass | ||||||||
Tumors | ||||||||
Thymoma | + | + | + | Biopsy: | ![]() CT scan showing presence of voluminous expansive lesion of 6 cm in the upper anterior mediastinum without infiltration of surrounding tissues signs with modest enhancement. Case courtesy of Dr. Domenico Nicoletti (Picture courtesy: Radiopedia) |
Associated condition
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Fatty mass |
|
- | - | - | MRI: | ![]() Limited images of an MRI of the chest demonstrate the mass to be of fat density. Case courtesy of A.Prof Frank Gaillard (Picture courtesy: Radiopedia) |
Fatty mass can be: | |
Non-Hodgkin lymphoma |
|
+/- | +/- | +/- | Excisional lymph node biopsy with immunohistochemical study | ![]() CT scan showing large anterior mediastinal mass. This is most likely lymphoma. Moderate pericardial effusion. Case courtesy of A. Prof Frank Gaillard (Picture courtesy: Radiopedia) |
| |
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Hodgkin's lymphoma | Epstein-Barr virus
|
Other
|
+ | + | +/- | Lymph node biopsy with immunohistochemistry
|
![]() CT scan showing A large soft tissue attenuation mass occupying the anterior mediastinal displaying homogeneous attenuation with low-density areas of cystic changes inside. It extends to the middle mediastinum to occupy the pretracheal space and involve the right hilum. Inferiorly it is inseparable from the anterior pericardium. Compression upon the SVC and encasement of the aorta and great vessels are noted. There is also mild right costal pleural thickening and enhancement suggesting infiltration with mild pleural effusion and abdominal retrocaval lymph nodes. Case courtesy of Dr. Ahmed Abdrabou (Picture courtesy: Radiopedia) |
Positron emission tomography (PET)
|
Mediastinal germ cell tumor
(Non-teratomatous) |
|
+ | - | - | Biopsy may help differentiate histopathological subtypes including: | ![]() CT scan showing A large heterogeneous anterior mediastinal mass, pathologically shown to be a germ cell tumor. Case courtesy of Radswiki (Picture courtesy: Radiopedia) |
CT scan:
Laboratory finding: | |
Teratoma |
|
Benign
|
+/- | +/- | +/- | Chest CT scan:
|
![]() CT scan showing A large teratoma in anterior mediastinum. Case courtesy of Dr. Gagandeep Singh (Picture courtesy: Radiopedia) |
|
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Cystic mass | ||||||||
Thymic cyst | Congenital
|
- | - | + | Biopsy with histopathology and cytology | ![]() CT scan showing A thymic mass corresponds to a cystic lesion. Case courtesy of Dr. Stefan Ludwig (Picture courtesy: Radiopedia) |
CT scan: | |
Thyroid gland disease | ||||||||
Mediastinal goiter |
|
+ | + | - | Radioactive iodine scan:
|
![]() CT scan showing A goitrous left lobe 9 cm in its greatest dimension (craniocaudal) extending posterior to the great vessels, 3.4cm below the top of the manubrium. The tracheal axis is shifted to the right and about 2cm below the cricoid cartilage, the trachea is compresssed for a length of 5cm, causing approx. 40% tracheal lumen cross sectional narrowing. Case courtesy of Dr Varun Babu Picture courtesy: Radiopedia) |
Hyperactive gland (hyperthyroid):
Hypoactive gland (hypothyroid): Normal functioning gland (euthyroid): | |
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Middle mediastinal mass | ||||||||
Cardiovascular Disease | ||||||||
Pericardial effusion |
|
|
+ | +/- | - | Echocardiography guided pericardiocentesis:
|
![]() CT scan showing pericardial effusion is evident (increased fluid-density around the heart) and this is the cause of the enlarged cardiac silhouette on chest x-ray. Numerous axillary and mediastinal lymph nodes. Case courtesy of A.Prof Frank Gaillard (Picture courtesy: Radiopedia) |
Physical findings:
EKG:
|
Aortic dissection | + | +/- | + | MRI: | ![]() CT scan showing dilatation of aortic root, ascending aorta, aortic arch and descending aorta. An intimal flap is seen extending from the aortic root proximally to below the origin of the renal arteries distally dividing the aortic lumen into true and false lumens . Case courtesy of Dr Prashant Mudgal (Picture courtesy: Radiopedia) |
TEE:
CTA:
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Superior vena cava obstruction | Compression of SVC from: |
|
+ | + | ++ | Contrast-enhanced CT scan:
|
![]() CT scan showing a large right upper lobe mass abuts the right brachiocephalic vein and SVC. Case courtesy of Dr Henry Knipe (Picture courtesy: Radiopedia) |
Invasive contrast venography:
|
Partial anomalous pulmonary venous connection |
|
+ | - | - | MRI with contrast:
|
![]() CT scan showing the anomalous origin of the right subclavian artery. traversing behind esophagus as it crosses midline from left to right. Case courtesy of Dr Piyush P Siwach (Picture courtesy: Radiopedia) |
Associated with
PFT:
| |
Gastrointestinal tract disease | ||||||||
Esophageal achalasia |
|
+ | + | - | High resolution manometry (HRM): | ![]() CT scan showing uniform dilatation of the esophagus with air-fluid level. Patchy consolidation in the upper segment of the right lower lobe likely due to aspiration. Case courtesy of Dr Hani Salam (Picture courtesy: Radiopedia) |
X ray:
| |
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Esophageal cancer |
|
|
- | + | - | Endoscopy with biopsy:
|
![]() CT scan showing irregular circumferential thickening of the mid oesophagus with oesophageal dilatation of the proximal segment, invasion of the adjacent right pleura, periosteal reaction without definite invasion of the right 2nd and 3rd ribs, subcarinal lymph node and multiple bilateral metastatic pulmonary nodules Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopedia) |
Barium swallow:
|
Esophageal rupture |
|
Other: Patients with cervical perforations can present with |
+ | + | - | Esophagogram:
|
![]() CT scan showing extensive pneumomediastinum and fluid in the mediastinum. Proximal oesophagus is air-filled and distended to the level of T7 and after this it is largely collapsed. Moderate sized bilateral pleural effusions and a small right apical pneumothorax. Severe centrilobular emphysema. Case courtesy of RMH Core Conditions (Picture courtesy: Radiopedia) |
CT scan:
|
Hiatus hernia |
|
- | + | - | High resolution manometry with esophageal pressure topography (EPT):
|
![]() CT scan shows herniation of stomach into the thorax through the hiatus with displacement of gastro-oesophageal junction. Case courtesy of DrDrsmail Kabakus (Picture courtesy: Radiopedia) |
Ultrasound:
Ultrasound in pediatric population:
| |
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Pulmonary disease | ||||||||
Hilar lymphadenopathy | Lymphadenopathy:
|
Constituitional symptoms like: | + | - | - | Lymph node biopsy and histopathology | ![]() CT scan shows bi-hilar lymphadenopathy and reticulonodular infiltrates. Case courtesy of Dr Ruslan Asadov (Picture courtesy: Radiopedia) |
CT scan |
Pneumomediastinum |
|
|
+ | - | - | CT scan:
Pediatric pneumomediastinum: |
![]() CT scan shows extensipneumomediastiumium is demonstrated throughout the chest with no pneumothorax. Case courtesy of A.Prof Frank Gaillard Picture courtesy: Radiopedia) |
Physical exam:
|
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Sarcoidosis |
Immune system
|
Cutaneous sarcoidosis
|
+ | - | - | Endoscopy with biopsy and histopathology
|
![]() CT scan shows extensive calcified lymph nodiiniin mediastinum, extensive architectural distortion of lung tissue, associated with marked fibrosis. Multiple pulmonary nodules are present in both lungs. Case courtesy of Prof Oliver Hennessy (Picture courtesy: Radiopedia) |
Laboratory findings:
|
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Infectious disease | ||||||||
Mediastinitis |
Risk factors: |
+ | - | - | Culture and sensitivity of mediastinal tissue collected by biopsy/aspiration | ![]() CT scan shows airway narrowing of the right lower lobe bronchus. There is thickening of the right pleura and right interlobular septae. There are partially calcified right hilar and mediastinal lymph nodes. Case courtesy of Dr Darel E Heitkamp (Picture courtesy: Radiopedia) |
Physical exam
| |
Anthrax | B. anthracis
People at higher risk include
|
+ | - | - | Culture and sensitivity: | ![]() CT scan shows showing bilateral pulmonary consolidation (yellow arrows) and pleural effusions (blue arrows). Case courtesy and picture courtesy: Centers for Disease Control and Prevention |
CT scan
| |
Tuberculosis | M. tuberculosis
Traveling or living in endemic regions (Sub-saharan African, Russia, India, Pakistan, China)
The risk of contracting TB increases in:
|
|
+ | - | - | Culture and sensitivity | ![]() CT scan shows the cavity (arrows) and extensive endobronchial spread particularly within the left upper lobe (Circle). In places there is a tree-in-bud appearance. Case courtesy of DDrNatalie Yang (Picture courtesy: Radiopedia) |
Chest X-ray
|
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Cystic mass | ||||||||
Bronchogenic cyst |
|
|
+ | - | - | CT scan | ![]() CT scan shows a large fluid density cystic structure abutting the right side of the superior mediastinum without evidence of invasion into either the mediastinum or the lung. It is well circumscribed and has appearances most consistent with a bronchogenic cyst. Case courtesy of Dr Gagandeep Choudhary (Picture courtesy: Radiopedia) |
CT scan:
|
Esophageal duplication cysts |
|
|
- | + | - | Endoscopic ultrasound (EUS)
|
![]() CT scan shows in the posterior mediastinum, to the left of the esophagus and below the level of the carina is a low attenuation (20 HU), a non-enhancing mass which abuts and displaces the esophagus to the right side. Appearance and location are suggestive of foregut duplication cyst. Case courtesy of Dr Alexandra Stanislavsky (Picture courtesy: Radiopedia) |
Endoscopic ultrasound-guided FNA
|
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Lymphangioma |
|
|
+ | + | - | Histopathology and cytology | ![]() 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 |
|
Chronic inflammatory disease | ||||||||
Churg-Strauss syndrome | + | +/- | - | Lung biopsy
4 out of 6 positive :
|
![]() CT scan shows peripheral consolidation / ground glass opacity and solid centrilobular nodulesnon-cavitateded), except the left part which underwent slight changes with now a moderate pleural effusion. Case courtesy oDrDr Fabien Ho (Picture courtesy: Radiopedia) |
High-resolution computerized tomography (HRCT):
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Posterior mediastinal mass | ||||||||
Cystic mass | ||||||||
Mediastinal neurenteric cyst | + | +/- | - | CT scan:
|
![]() CT showing a well-defined posterior mediastinal cystic lesion (highlight) is seen with air-fluid levels showing mucosal enhancement. A cystic mass is extending in between and is displacing descending thoracic aorta anteriorly (curved arrow), azygous vein posteriorly (straight arrow). Source: Case courtesy of Taruna Yadav et al |
Postnatal chest X-ray:
| ||
Pancreatic pseudocyst |
|
- | - | - | Histopathology and cytology of cyst and fluid content | ![]() CT scan showing a low attenuating thick walled peripherally enhancing cystic lesion, measuring approximately 5.2 x 2.8 cm noted in the lower aspect of posterior mediastinum and appears to arise adjacent to the esophageal hiatus and extending up to the carina. Case courtesy of Dr Prashant Mudgal (Picture courtesy:Radiopedia) |
CT scan
| |
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Central nervous system disease | ||||||||
Meningocele |
Maternal nutritional factors
Environmental factors
|
Symptoms depend on the severity of the defect
Difficulties with executive functions including:
|
- | - | - | Prenatal 2D/3D ultrasound:
|
![]() CT scan showing Right thoracic CSF cyst with smaller left sided out-pouching. Case courtesy of Dr G Balachandran (Picture courtesy: Radiopedia) |
Laboratory tests:
MRI:
|
Neurilemmoma |
|
- | - | - | Biopsy with histopathology | ![]() 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) |
MRI | |
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, MRI: Magnetic resonance imaging, CNS: Central nervous system, CSF: Cerebrospinal fluid, FNA: Fine needle aspiration, CBC: Complete blood count, COPD: Chronic obstructive pulmonary disease, AIDS: Acquired immune deficiency syndrome, HIV: Human immunodeficiency virus, Hep C: Hepatitis C virus, HTLV-1: human T-lymphotropic virus, EBV: Epstein Barr virus, HHV-8: Human herpes virus-8 |
References
- ↑ 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.
- ↑ Scagliori E, Evangelista L, Panunzio A, Calabrese F, Nannini N, Polverosi R; et al. (2015). "Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review". Thorac Cancer. 6 (4): 433–42. doi:10.1111/1759-7714.12197. PMC 4511321. PMID 26273398.
- ↑ Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Retrieved 2012-01-18. Unknown parameter
|month=
ignored (help) - ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ K. J. Flavell & P. G. Murray (2000). "Hodgkin's disease and the Epstein-Barr virus". Molecular pathology : MP. 53 (5): 262–269. PMID 11091850. Unknown parameter
|month=
ignored (help) - ↑ J. J. Goedert, T. R. Cote, P. Virgo, S. M. Scoppa, D. W. Kingma, M. H. Gail, E. S. Jaffe & R. J. Biggar (1998). "Spectrum of AIDS-associated malignant disorders". Lancet (London, England). 351 (9119): 1833–1839. PMID 9652666. Unknown parameter
|month=
ignored (help) - ↑ M. Tinguely, R. Vonlanthen, E. Muller, C. C. Dommann-Scherrer, J. Schneider, J. A. Laissue & B. Borisch (1998). "Hodgkin's disease-like lymphoproliferative disorders in patients with different underlying immunodeficiency states". Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 11 (4): 307–312. PMID 9578079. Unknown parameter
|month=
ignored (help) - ↑ Vardhana S, Younes A (2016). "The immune microenvironment in Hodgkin lymphoma: T cells, B cells, and immune checkpoints". Haematologica. 101 (7): 794–802. doi:10.3324/haematol.2015.132761. PMC 5004458. PMID 27365459.
- ↑ Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/diagnosis/?region=ab Accessed on September 11, 2015
- ↑ 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 14.11 14.12 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ "Benign thyroid enlargement (non-toxic multinodular goiter): Overview".
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
- ↑ Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
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(help) - ↑ Chiu CY, Wong KS, Yao TC, Huang JL (March 2005). "Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children". Asian Pac. J. Allergy Immunol. 23 (1): 19–22. PMID 15997870.
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