Mediastinal mass causes: Difference between revisions

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==Overview==
==Overview==
 
The [[mediastinum]] is a non-delineated group of structures in the [[Thorax|thorax (chest)]], surrounded by [[loose connective tissue]]. It is the central [[Compartment (anatomy)|compartment]] of the [[thoracic cavity]]. It contains the [[heart]], the [[great vessels]] of the [[heart]], [[esophagus]], [[trachea]], [[thymus]], and [[Lymph node|lymph nodes]] of the [[Mediastinum|central chest]]. A wide variety of [[Disease|diseases]] involving these organs can present as a mediastinal mass or widening of the [[mediastinum]] on [[imaging studies]].


==Causes==
==Causes==
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| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |  
| style="width:75%" bgcolor="Beige" ; border="1" |  
*[[Aortitis]]
*[[Aortic dissection]]
*[[Aortic dissection]]
*[[Partial anomalous pulmonary venous connection]]
*[[Partial anomalous pulmonary venous connection]]
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
| bgcolor="Beige" | [[Dermoid cyst]]
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
| bgcolor="Beige" |  
| bgcolor="Beige" |
*Acute descending necrotizing mediastinitis
* No underlying causes
*[[Goitre]]
*[[Thyroid cancer]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
| bgcolor="Beige" |  
| bgcolor="Beige" |  
*[[Goitre]], when more than 50% of the mass is located below the thoracic inlet, is termed intrathoracic goitre<ref name="pmid9818814">{{cite journal| author=Netterville JL, Coleman SC, Smith JC, Smith MM, Day TA, Burkey BB| title=Management of substernal goiter. | journal=Laryngoscope | year= 1998 | volume= 108 | issue= 11 Pt 1 | pages= 1611-7 | pmid=9818814 | doi= | pmc= | url= }} </ref> which appear as mediastinal mass.
*[[Goitre]]
*[[Thyroid cancer]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
| bgcolor="Beige" | Intrathoracic [[goitre]]
| bgcolor="Beige" |
* Intrathoracic [[goitre]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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*[[Esophageal achalasia]]
*[[Esophageal achalasia]]
*[[Esophageal cancer]]
*[[Esophageal cancer]]
*[[Esophageal rupture]] leading to [[pneumomediastinum]] secondary to excessive [[vomiting]].
*[[Esophageal rupture]]
*[[Hiatus hernia]]
*[[Hiatus hernia]]
*[[Pancreatic pseudocyst]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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| bgcolor="Beige" |
| bgcolor="Beige" |
*[[Hilar lymphadenopathy]]
*[[Hilar lymphadenopathy]]
*[[Lymphoma]]
*[[Non-Hodgkin lymphoma]]
*[[Non-Hodgkin lymphoma]]
*[[Thymoma]]
*[[Thymoma]]
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
| bgcolor="Beige" | [[Mediastinitis]]
| bgcolor="Beige" |
* [[Mediastinitis]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
| bgcolor="Beige" |  
| bgcolor="Beige" |  
*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> Dental infections are the cause in 60-70% of the cases<ref name="pmid10760723">{{cite journal| author=Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J| title=Descending necrotizing mediastinitis due to odontogenic infections. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 2000 | volume= 89 | issue= 4 | pages= 412-9 | pmid=10760723 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760723  }} </ref>. Can also occur secondary to head and neck infections. [[Streptococcus|Hemolytic group streptococci]] and [[Bacteroides]] species are the common organisms.
*[[Anthrax]]
*[[Anthrax]]- 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>
*[[Mediastinitis]]
*[[Mediastinitis]]
*[[Tularemia]]
*Mediastinal [[abscess]]
*[[Histoplasmosis]]
*[[Psittacosis]]
*[[Tuberculosis]]
*[[Tuberculosis]]
|-
|-
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
| bgcolor="Beige" | Mediastinal [[neurilemmoma]] may originate from right phrenic nerve<ref name="pmid10064956">{{cite journal| author=Hirose H, Ohmori K, Nakaoka Y, Kitamura K, Muramatsu T, Namiki Y et al.| title=[Mediastinal neurilemmoma originating in the right phrenic nerve: a case report]. | journal=Nihon Kokyuki Gakkai Zasshi | year= 1998 | volume= 36 | issue= 12 | pages= 1027-31 | pmid=10064956 | doi= | pmc= | url= }} </ref>,  intrathoracic vagal nerve<ref name="pmid8152184">{{cite journal| author=Ito I, Komota K, Nakajima T, Ishibashi K, Kawazoe K| title=[A case of mediastinal neurilemmoma originating from the intrathoracic vagal nerve]. | journal=Kyobu Geka | year= 1994 | volume= 47 | issue= 4 | pages= 325-7 | pmid=8152184 | doi= | pmc= | url= }} </ref>
| bgcolor="Beige" |
* [[Spina bifida|Meningocele]]
* [[Neurilemmoma]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | Intrathoracic [[goitre]]
| bgcolor="Beige" |
* Intrathoracic [[goitre]]
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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| bgcolor="Beige" |
| bgcolor="Beige" |
*[[Esophageal cancer]]
*[[Esophageal cancer]]
*[[Lymphoma]]
*[[Mediastinal germ cell tumor]]
*[[Mediastinal germ cell tumor]]
*[[Mediastinal tumor]]
*[[Mediastinal tumor]]
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*[[Thymoma]]
*[[Thymoma]]
*[[Thyroid cancer]]
*[[Thyroid cancer]]
* Metastatis to pericardium
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
| bgcolor="Beige" | Inhaled recreational drugs such as [[cocaine]] which induced bronschospasm, increased alveolar pressure followed by alveolar rupture leading to [[interstitial emphysema]] and [[pneumomediastinum]]<ref name="pmid1416301">{{cite journal| author=Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF| title=Spontaneous pneumomediastinum: clinical and natural history. | journal=Ann Emerg Med | year= 1992 | volume= 21 | issue= 10 | pages= 1222-7 | pmid=1416301 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1416301  }} </ref>.
| bgcolor="Beige" |
*[[silicosis]]
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
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|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
| bgcolor="Beige" |
* No underlying causes
|-
|-
|- bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
| bgcolor="Beige" |  
| bgcolor="Beige" |
*[[Dermoid cyst]] is thick-walled and contains various tissue materials of skin, hair, occasionally teeth, and caseous (cheesy) substance. They are usually found in the front of the chest, but rarely are located within the pericardium. If not removed, it may get infected and rupture.
* No underlying causes
*Supine AP [[chest x ray]] can yield a [[false positive]] "widened mediastinum".
|-
|-
|}
|}


=== Causes in Alphabetical Order ===
=== Causes in Alphabetical Order ===
*[[Anthrax]]: This is a classic finding associated with inhaled [[anthrax]]. A widened mediastinum was found in 7 of the first 10 victims infected ''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>
<div style="-moz-column-count:3; column-count:3;">
*[[Anthrax]]
*[[Aortic dissection]]
*[[Aortic dissection]]
*[[Bronchogenic cyst]]
*[[Bronchogenic cyst]]
Line 276: Line 279:
*[[Thyroid cancer]]
*[[Thyroid cancer]]
*[[Tuberculosis]]
*[[Tuberculosis]]
</div>


==References==
==References==

Latest revision as of 16:44, 12 March 2019

Mediastinal mass Microchapters

Home

Overview

Anatomy of Mediastinum

Causes

Differentiating Mediastinal Mass from other Diseases

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 these organs can present as a mediastinal mass or widening of the mediastinum on imaging studies.

Causes

Following can appear as a mediastinal mass on imaging studies:

Disease
Cardiovascular causes
Gastrointestinal causes
Pulmonary causes
CNS diseases
Thyroid diseases
Mediastinal tumors
Cystic mass
Other

Causes by Organ System

Cardiovascular
Chemical / poisoning
  • No underlying causes
Dermatologic
  • No underlying causes
Drug Side Effect
  • No underlying causes
Ear Nose Throat
  • No underlying causes
Endocrine
Environmental
Gastroenterologic
Genetic No underlying causes
Hematologic
Iatrogenic
Infectious Disease
Musculoskeletal / Ortho No underlying causes
Neurologic
Nutritional / Metabolic
Obstetric/Gynecologic
  • No underlying causes
Oncologic
Opthalmologic
  • No underlying causes
Overdose / Toxicity
  • No underlying causes
Psychiatric
  • No underlying causes
Pulmonary
Renal / Electrolyte
  • No underlying causes
Rheum / Immune / Allergy
Sexual
  • No underlying causes
Trauma
Urologic
  • No underlying causes
Miscellaneous
  • No underlying causes

Causes in Alphabetical Order

References

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