Sandbox:Trusha
Editor-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.
- 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[2] |
|
|
+ | + | - | 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:
| |
Aortic dissection[2] | |||||||||
Superior vena cava obstruction[2] | |||||||||
Partial anomalous pulmonary venous connection[2] | |||||||||
GI disease | Esophageal achalasia | ||||||||
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 |
- 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.