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__NOTOC__
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{{SI}}
{{Mediastinal mass}}
{{CMG}}; {{AE}} {{Trusha}}, {{AM}}
 
{{CMG}}; {{AE}}{{Trusha}}


{{SK}} Mediastinal enlargement; mass in the mediastinum
{{SK}} Mediastinal enlargement; mass in the mediastinum


==Differential diagnosis of mediastinal mass==
==Overview==
Wide variety of medical conditions can present as a mediastinal mass on [[Radiology|radiological imaging]].
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]]. The [[mediastinum]] lies between the [[Visceral pleura|right and left pleura]] in and near the [[Anatomical terms of location|median sagittal plane]] of the [[chest]]. It extends from the [[sternum]] in front to the [[vertebral column]] behind, and contains all the [[Chest|thoracic]] [[viscera]] except the [[lungs]]. On the basis of [[Computed tomography|cross-sectional imaging]], [[mediastinum]] can be divided into 3 groups: 1) [[Anterior mediastinum|Prevascular compartment:]] which contains [[thymus]], [[fat]], [[Lymph node|lymph nodes]] and [[Brachiocephalic vein|left brachiocephalic vein]]. 2) [[Middle mediastinum|Visceral compartment]], which contains [[trachea]], [[Carina of trachea|carina]], [[esophagus]], [[Lymph node|lymph nodes]], [[heart]], [[Ascending aorta|ascending thoracic aorta]], [[aortic arch]], [[Descending aorta|descending thoracic aorta,]] [[superior vena cava]], [[Pulmonary arteries|intrapericardial pulmonary arteries]], and [[thoracic duct]]. and 3) [[Posterior mediastinum|Paravertebral compartment:]] which contains the [[Thoracic vertebrae|thoracic spine]] and paravertebral tissue. A wide variety of [[Mediastinal mass causes|diseases]] involving these [[Organ (anatomy)|organs]] can present as a mediastinal mass or widening of the [[mediastinum]] on [[imaging studies]]. Mediastinal widening is [[Diagnosis|diagnosed]] by the [[mediastinum]] measuring greater than 8 cm in width on [[Chest x-ray|PA chest x-ray]]. The mediastinal mass may present with [[Symptom|symptoms]] or even without any [[Symptom|symptoms]]. A mediastinal mass may cause a variety of [[Symptom|symptoms]] by the [[Tumor|mass]] pressing against other [[Mediastinum|mediastinal structures]], collectively known as mediastinal syndrome. Mediastinal mass can be differentiated according to the content of the mass such as [[Cyst|cystic mass]], [[Fat|fatty mass]] or [[Neoplasm|solid (tumor)]]. Depending on location and composition of the [[Tumor|mass]] further [[diagnosis]] is made by specific [[imaging studies]], [[Endoscopy|endoscopic studies]], [[Biopsy|tissue biopsies]], [[Histopathology|histopathological studies]] and/or growth of [[microorganism]] on specific [[Growth medium|culture medium]].
* Mediastinal mass may cause [[obstruction]], [[entrapment]] or [[Infiltration (medical)|infiltration]] of other [[Mediastinum|mediastinal organs]] such as: [[Trachea]], [[Bronchus|bronchi]], [[esophagus]], [[aorta]], [[SVC|superior vena cava (SVC)]] or [[heart]].<ref name="pmid27698718">{{cite journal |vauthors=Zardi EM, Pipita ME, Afeltra A |title=Mediastinal syndrome: A report of three cases |journal=Exp Ther Med |volume=12 |issue=4 |pages=2237–2240 |date=October 2016 |pmid=27698718 |pmc=5038184 |doi=10.3892/etm.2016.3596 |url=}}</ref>
* 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 limb|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 (medicine)|complication]] of [[mediastinal syndrome]] and a [[medical emergency]].  


{|
==Anatomy of mediastinum==
| colspan="9" |'''<small>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</small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small>
* The [[mediastinum]] lies between the [[Visceral pleura|right and left pleura]] in and near the [[Anatomical terms of location|median sagittal plane]] of the [[chest]].  
|-
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Causes/risk factors'''
! colspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical presentation
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''General symptoms'''
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Mediastinal syndrome
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
! colspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" | Anterior mediastinal mass
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" | Tumors
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thymoma|'''Thymoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Human foamy virus]]
* [[Epstein-Barr virus]]
* [[HTLV|Human T-cell lymphotropic virus]]
* [[MEN 1 syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
* [[wheezing]]
* [[Chest pain]]
* [[Muscle weakness]] ([[Myasthenia gravis|MG]])
* [[Anemia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]:
* [[Epithelium|Epithelial cells]]
* [[Lymphoblasts|Immature lymphocytes]]
* [[T cell|Immature T cells]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Thymoma GIF final.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/38443 Radiopedia])]]


| style="background: #F5F5F5; padding: 5px;" |'''Associated condition'''
* It extends from the [[sternum]] in front to the [[vertebral column]] behind, and contains all the [[Chest|thoracic]] [[viscera]] except the [[lungs]]. It may be divided for purposes of description into two parts:
* [[Neuromuscular]]  
** '''Superior mediastinum:''' Above the upper level of the [[pericardium]], which is named the [[superior mediastinum]] with its [[superior]] limit at the [[Superior thoracic aperture|superior thoracic opening]] and its [[Anatomical terms of location|inferior]] limit at the plane from the [[sternal angle]] to the [[Thoracic vertebrae|disc of T4-T5]] (plane of Ludwig)
** [[Myasthenia gravis]]
** '''Inferior mediastinum''': Below the upper level of the [[pericardium]]. This lower portion is again subdivided into three parts:
** [[Neuromyotonia]]
*** In front of the pericardium, the [[anterior mediastinum]]
** [[Rippling muscle disease]]
*** Containing the pericardium and its contents, the [[middle mediastinum]]
** [[Polymyositis and dermatomyositis|Polymyositis/dermatomyositis]]
*** Behind the pericardium, the [[posterior mediastinum]]
** [[Encephalitis]] ([[Limbic system|limbic]], [[Cortical area|cortical]] and [[Brain stem|brainstem]])
*** It is surrounded by the [[Thoracic cavity|chest wall]] [[Anatomical terms of location|anteriorly]], the [[Lung|lungs]] [[Lateral|laterally]] and the [[Vertebral column|spine]] [[Anatomical terms of location|posteriorly]].
** [[Intestinal pseudoobstruction]]
*** It is continuous with the [[loose connective tissue]] of the [[neck]], and extends [[Anatomical terms of location|inferiorly]] into the [[Diaphragm (anatomy)|diaphragm]].
* [[Hematological]]
** [[Anemia]]: [[pure red cell aplasia]], [[pernicious anemia]], [[hemolytic anemia]], [[aplastic anemia]]
** Other isolated [[Cytopenia|cytopenias]]: [[eosinophils]], [[basophils]] [[neutrophils]]
** [[Immunodeficiency|Immunodeficiencies]]: [[Hypogammaglobulinaemia|hypogammaglobulinemia]]/- T-cell deficiencies [[Good syndrome|(Good syndrome)]]
* [[Dermatology|Dermatological]]
** [[Pemphigus]] ([[Pemphigus foliaceus|foliaceus]] or [[Paraneoplastic syndrome|paraneoplastic]])
** [[Lichen planus]]
** [[Alopecia areata]]
* [[Endocrine system|Endocrine]]
** [[Addison's disease|Addison disease]]
** [[Graves' disease|Grave's disease]]
** [[Cushing's disease]]
* Hepato-renal
** [[Glomerulonephritis]]
** [[Autoimmune hepatitis]]
* Systemic autoimmune diseases
** [[SLE]]
** [[Sjögren's syndrome]]
** [[Systemic sclerosis]]
** [[Graft-versus-host disease]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lipoma|Fatty mass]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid22021525">{{cite journal |vauthors=Molinari F, Bankier AA, Eisenberg RL |title=Fat-containing lesions in adult thoracic imaging |journal=AJR Am J Roentgenol |volume=197 |issue=5 |pages=W795–813 |date=November 2011 |pmid=22021525 |doi=10.2214/AJR.11.6932 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Anabolic steroid|Steroid use]]
* [[Cushing's syndrome]]
* [[Obesity]]
| style="background: #F5F5F5; padding: 5px;" |
* Mostly [[asymptomatic]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Magnetic resonance imaging|MRI:]]
* Well-defined encapsulated [[Tumor|mass]]
* Extensive [[fat]] content
* Small amounts of solid areas
* [[Fibrous]] septa
| style="background: #F5F5F5; padding: 5px;" |[[File:Mediastinal Lipoma GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/20044 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Fat|Fatty]] [[Tumor|mass]] can be:
* [[Lipoma]]
* [[Liposarcoma]]
* [[Thymolipoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Non-Hodgkin lymphoma|'''Non-Hodgkin lymphoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid26174528">{{cite journal| author=Sandlund JT| title=Non-Hodgkin Lymphoma in Children. | journal=Curr Hematol Malig Rep | year= 2015 | volume= 10 | issue= 3 | pages= 237-43 | pmid=26174528 | doi=10.1007/s11899-015-0277-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26174528  }}</ref><ref name="pmid28153383">{{cite journal| author=Armitage JO, Gascoyne RD, Lunning MA, Cavalli F| title=Non-Hodgkin lymphoma. | journal=Lancet | year= 2017 | volume= 390 | issue= 10091 | pages= 298-310 | pmid=28153383 | doi=10.1016/S0140-6736(16)32407-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28153383  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Age (above 60 years)
* Caucasians > African and Asian Americans
* Positive family history of first degree relative
* [[B cell|B-cell]] activating [[autoimmune disorders]]
* [[Radioactive contamination|Radiation exposure]]
* [[Infection|Infections]]
([[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis C|Hep C]], [[Human T-lymphotropic virus|HTLV-1]], [[Epstein Barr virus|EBV]], [[Kaposi's sarcoma-associated herpesvirus|HHV-8]], [[Helicobacter pylori|H. pylori]], [[psittacosis]], [[Campylobacter jejuni|Campylobacter jejuni)]]
* Previous [[cancer]] treatment
* [[Exposure effect|Exposure to chemicals and drugs]]
([[Pesticide|pesticides]], [[methotrexate]], [[TNF inhibitor|TNF inhibitors]], [[trichloroethylene]])
* [[Smoking|Cigarette smoking]] for ≥ 40 years
* [[Body mass index|BMI]] ≥30 kg/m2
* [[Diet (nutrition)|Diet]]
* Hair dyes
* [[Breast implant|Breast implants]]


*
* Note that clinical radiologists and anatomists categorize the mediastinum in slightly different ways.
| style="background: #F5F5F5; padding: 5px;" |
* [[lymphadenopathy|Painless lymphadenopathy]]
* [[Fever]]
* [[Weight loss]] and [[Anorexia (symptom)|anorexia]]
* [[Night sweats]]
* Constant [[Fatigue (physical)|fatigue]]
* [[Pruritis|Itchy skin]]
* [[Cough]]
* [[Shortness of breath]]
* [[Abdominal pain]] or [[swelling]]
* [[Constipation]]
* [[Nausea]]
* [[Vomiting]]
* [[Headache]]
* [[Personality changes]]
* [[Seizures]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |[[Lymph node biopsy|Excisional lymph node biopsy]] with [[Immunohistochemistry|immunohistochemical study]]
* [[CD20|CD 20+ cells]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Ant mediastinal Lymphoma GIF.gif|x200px|thumb| CT scan showing large anterior mediastinal mass. This is most likely lymphoma. Moderate pericardial effusion. Case courtesy of A. Prof Frank Gaillard (Picture courtesy: [https://radiopaedia.org/cases/29556 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Anemia|Anemia:]]
**Involvement of [[bone marrow]]
**[[Autoimmune hemolytic anemia|Autoimmune hemolysis]] and [[bleeding]]


* [[Thrombocytopenia]], [[leukopenia]], or [[pancytopenia]]
* The International Thymic Malignancy Interest Group (ITMIG) has developed a new scheme to divide [[Mediastinum|mediastinal cavity]] on the basis of [[Computed tomography|cross sectional imaging]] for better [[Diagnosis|diagnostic]] and [[Therapy|therapeutic]] purposes.<ref name="CarterBenveniste2017">{{cite journal|last1=Carter|first1=Brett W.|last2=Benveniste|first2=Marcelo F.|last3=Madan|first3=Rachna|last4=Godoy|first4=Myrna C.|last5=de Groot|first5=Patricia M.|last6=Truong|first6=Mylene T.|last7=Rosado-de-Christenson|first7=Melissa L.|last8=Marom|first8=Edith M.|title=ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses|journal=RadioGraphics|volume=37|issue=2|year=2017|pages=413–436|issn=0271-5333|doi=10.1148/rg.2017160095}}</ref>
* [[Lymphocytosis]] with [[Malignant|malignant cell]]
** [[Anterior mediastinum|Prevascular (anterior)]]
* [[Thrombocytosis]]
** [[Middle mediastinum|Visceral (middle)]]
** [[Posterior mediastinum|Paravertebral (posterior)]]  
{|
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''<big>International Thymic Malignancy Interest Group (ITMIG) Classification of Mediastinum</big>'''
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Compartments'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Boundaries'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Components'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Prevascular'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Hodgkin's lymphoma]]'''
<ref>{{Cite journal
| author = [[K. J. Flavell]] & [[P. G. Murray]]
| title = Hodgkin's disease and the Epstein-Barr virus
| journal = [[Molecular pathology : MP]]
| volume = 53
| issue = 5
| pages = 262–269
| year = 2000
| month = October
| pmid = 11091850
}}</ref><ref>{{Cite journal
| author = [[J. J. Goedert]], [[T. R. Cote]], [[P. Virgo]], [[S. M. Scoppa]], [[D. W. Kingma]], [[M. H. Gail]], [[E. S. Jaffe]] & [[R. J. Biggar]]
| title = Spectrum of AIDS-associated malignant disorders
| journal = [[Lancet (London, England)]]
| volume = 351
| issue = 9119
| pages = 1833–1839
| year = 1998
| month = June
| pmid = 9652666
}}</ref><ref>{{Cite journal
| author = [[M. Tinguely]], [[R. Vonlanthen]], [[E. Muller]], [[C. C. Dommann-Scherrer]], [[J. Schneider]], [[J. A. Laissue]] & [[B. Borisch]]
| title = Hodgkin's disease-like lymphoproliferative disorders in patients with different underlying immunodeficiency states
| journal = [[Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc]]
| volume = 11
| issue = 4
| pages = 307–312
| year = 1998
| month = April
| pmid = 9578079
}}</ref><ref name="pmid27365459">{{cite journal| author=Vardhana S, Younes A| title=The immune microenvironment in Hodgkin lymphoma: T cells, B cells, and immune checkpoints. | journal=Haematologica | year= 2016 | volume= 101 | issue= 7 | pages= 794-802 | pmid=27365459 | doi=10.3324/haematol.2015.132761 | pmc=5004458 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27365459  }}</ref><ref>Hodgkin-lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/hodgkin-lymphoma/diagnosis/?region=ab Accessed on September 11, 2015</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Epstein Barr virus|Epstein-Barr virus]]
* A history of [[infection]] with the [[Epstein-Barr virus]] (EBV)
[[Family history]]
* First-degree relatives
* Siblings of the same sex
[[HIV AIDS|HIV infection]]
* [[Human Immunodeficiency Virus (HIV)|HIV infection]] increases risk
[[Autoimmune diseases]]
* [[Rheumatoid arthritis]]
* [[Systemic lupus erythematosus]]
* [[Ulcerative colitis]]
* [[Immune thrombocytopenic purpura]]
* [[Sarcoidosis]]
[[Immunodeficiency]]
* [[Severe combined immunodeficiency]] ([[SCID]])
* [[Hypogammaglobulinemia]]
* [[Hyper IgM syndrome|Hyperimmunoglobulin M syndrome]]
* [[Primary immunodeficiency|Congenital immunodeficiency]]
* [[Organ transplant]] or [[Allograft|allogeneic]] [[bone marrow transplant]]
[[Tobacco smoking]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Lymphadenopathy|Painless lymphadenopathy]] with a rubbery consistency
[[B symptoms|Systemic B symptoms]]:
* [[Fever]] ([[Pel-Ebstein fever]]): persistent temperature >38°C (>100.4°F)
* [[night sweats]]
* [[Weight loss]] >10% within the past 6 months
Other
* [[Itch|Pruritus]]
* [[Fatigue]]
[[Mass effect (medicine)|Mass effect]]
* [[Chest pain]]
* [[Cough]]
* [[Pain]] or [[Satiety|fullness]] below the [[Rib|ribs]] due to [[Splenomegaly|swollen spleen]] or [[Hepatomegaly|liver]]
* [[Pain]] in [[Lymph node|lymph nodes]] after drinking [[alcohol]]
* [[Skin]] [[blushing]] or [[flushing]]
* [[Bone pain]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |[[Lymph node biopsy]] with [[immunohistochemistry]]
* [[Reed-Sternberg cell|Reed-Sternberg cells]]
* [[CD15]] and [[CD30]] +
| style="background: #F5F5F5; padding: 5px;" |[[File:Hodgkin's disease ant mediastinum GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/24432 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Positron emission tomography|Positron emission tomography (PET)]]
*Detect small deposits
*Monitor the response to treatment
*Detect recurrences
*Quantitate the size of [[Lymph node|lymph nodes]] with precision
*Assess for [[bone marrow]] involvement
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Mediastinal germ cell tumor]]'''
(Non-teratomatous)
 
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Exclusively in males
* 20s - 40s age
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
* [[Cough]]
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
* [[Wheeze|Wheezing]]
* '''Anterior:''' [[Sternum]]
* [[Stridor]]
* '''Posterior:''' [[Anatomical terms of location|Anterior]] aspect of the [[pericardium]]
* [[Weight loss]]
* '''Lateral:''' [[Parietal pleura|Parietal mediastinal pleura]]
* [[Fever]]
* [[Sleep hyperhidrosis|Night sweats]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]]:
* [[Endodermal sinus tumor|Yolk sac tumor]]
* [[Endodermal sinus tumor]]
* [[Embryonal carcinoma]]
* [[Choriocarcinoma]]
* [[Germ cell tumor|Mixed germ cell tumor]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Germcelltumor mediastinum.gif|x200px|thumb| CT scan showing A large heterogeneous anterior mediastinal mass, pathologically shown to be a germ cell tumor.  Case courtesy of Radswiki (Picture courtesy: [https://radiopaedia.org/cases/12086 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan:]]
* [[Homogeneity|Homogenous appearance]]
* [[Hemorrhage]] and [[Necrosis|coagulation necrosis]]
* [[Metastasis]] to [[Lymph node metastases|lymph nodes]] and [[Bone metastasis|bone]]
* [[Germ cell tumors|Non-seminomatous germ cell tumors]] present as large [[Tumor|masses]] with marked [[heterogeneous]] attenuation
* [[Invasive (medical)|Invasion]] of adjacent structures and [[Metastasis|distant metastasis]]
* [[Pleural effusion|Pleural]] and [[pericardial effusion]]
Laboratory finding:
* [[Alpha-fetoprotein|AFP]] and [[Beta-hCG|ß-hCG]] levels
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma|'''Teratoma''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid24426558">{{cite journal |vauthors=Yalagachin GH |title=Anterior mediastinal teratoma- a case report with review of literature |journal=Indian J Surg |volume=75 |issue=Suppl 1 |pages=182–4 |date=June 2013 |pmid=24426558 |doi=10.1007/s12262-012-0569-6 |url=}}</ref><ref name="pmid26251691">{{cite journal |vauthors=No TH, Seol SH, Seo GW, Kim DI, Yang SY, Jeong CH, Hwang YH, Kim JY |title=Benign Mature Teratoma in Anterior Mediastinum |journal=J Clin Med Res |volume=7 |issue=9 |pages=726–8 |date=September 2015 |pmid=26251691 |pmc=4522994 |doi=10.14740/jocmr2270w |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Benign equal in men and women
* [[Thymus]]
* [[Malignant]] more common in men
* [[Pediatrics|Pediatric population]] higher risk
| style="background: #F5F5F5; padding: 5px;" |[[Benign]]
* [[Asymptomatic]]
[[Malignant]]
* [[Cough]]
* [[Chest pain]]
* [[Trichoptysis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px;" |[[CT scan|Chest CT scan:]]
* Location
* [[Metastasis]]
* Intrinsic structure
* Soft tissue
* [[Fat]]
* [[Fat]]
* [[Calcification]]
* [[Lymph node|Lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Teratoma GIF.gif|x200px|thumb| CT scan showing A large teratoma in anterior mediastinum. Case courtesy of Dr. Gagandeep Singh (Picture courtesy: [https://radiopaedia.org/cases/8593 Radiopedia])]]
* [[Brachiocephalic vein|Left brachiocephalic vein]]  
| style="background: #F5F5F5; padding: 5px;" |N/A
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Cystic mass'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Thymic cyst]]'''
<ref name="pmid23225215" /><ref name="KondovKondov2017">{{cite journal|last1=Kondov|first1=Goran|last2=Kondov|first2=Borislav|last3=Srceva|first3=Marija Jovanovska|last4=Damjanovski|first4=Goge|last5=Ferati|first5=Imran|last6=Karapetrov|first6=Ivan|last7=Topuzovska|first7=Irena Kondova|last8=Tanevska|first8=Nikolina|last9=Kokareva|first9=Anita|title=Giant Mediastinal Thymic Cyst|journal=PRILOZI|volume=38|issue=2|year=2017|pages=139–145|issn=1857-8985|doi=10.1515/prilozi-2017-0032}}</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Congenital disorder|Congenital]]
* Unilocular
[[Acquired disorder|Acquired]]
* Multilocular:
** [[Teratoma]]
** [[Lymphoma]]
** [[Thymic carcinoma]]
** [[Autoimmune disorders]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Asymptomatic]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] with [[histopathology]] and [[Cell biology|cytology]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Thymic cyst.gif|x200px|thumb| CT scan showing A thymic mass corresponds to a cystic lesion. Case courtesy of Dr. Stefan Ludwig (Picture courtesy: [https://radiopaedia.org/cases/13893 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan:]]
* Oval shape
* Smooth contour
* Midline location
* [[Calcification|Calcified]]
* Septate [[cyst]]
* Fluid attenuation
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Thyroid gland disease'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Goitre|'''Mediastinal goiter''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="urlBenign thyroid enlargement (non-toxic multinodular goiter): Overview">{{cite web |url=http://endocrinediseases.org/thyroid/goiter.shtml |title=Benign thyroid enlargement (non-toxic multinodular goiter): Overview |format= |work= |accessdate=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Iodine deficiency]]
* Female gender
* Age over 50 years
* Personal or family history
* Certain medications
** [[Immunosuppressant|Immunosuppressants]]
** [[Antiretroviral|Antiretrovirals]]
** [[Amiodarone]]
** [[Lithium]]
* [[Radiation]]
| style="background: #F5F5F5; padding: 5px;" |
* [[swelling]] at the base of your [[neck]]
* Tight feeling in [[throat]]
* [[Cough]]
* [[Hoarseness]]
* [[Fatigue]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Radioactive iodine uptake|Radioactive iodine scan:]]
* [[Nodule (medicine)|Nodules]]
* Size
* Function of the gland: [[Hyperthyroidism|↑ hyperthyroidism]], [[Hypothyroidism|↓ hypothyroidism]] or normal ([[euthyroid]])
| style="background: #F5F5F5; padding: 5px;" |[[File:Mediastinal goiter.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/17104 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Hyperthyroidism|Hyperactive gland (hyperthyroid):]]
* [[Graves' disease|Grave's disease]]
[[Hypothyroidism|Hypoactive gland (hypothyroid):]]
* [[Hashimoto's thyroiditis|Hashimoto thyroiditis]]
Normal functioning [[Thyroid Gland|gland]] [[Euthyroid|(euthyroid):]]
* [[Goiter classification|Benign thyroid enlargement (non toxic multinodular goiter)]] 
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Visceral'''
! colspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Middle mediastinal mass
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" | Cardiovascular Disease
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pericardial effusion|'''Pericardial effusion''']]
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid26317273">{{cite journal |vauthors=Vanneman MW, Fikry K, Quraishi SA, Schoenfeld W |title=A Young Man with a Mediastinal Mass and Sudden Cardiac Arrest |journal=Ann Am Thorac Soc |volume=12 |issue=8 |pages=1235–9 |date=August 2015 |pmid=26317273 |doi=10.1513/AnnalsATS.201504-212CC |url=}}</ref><ref name="pmid10579740">{{cite journal |vauthors=Salem K, Mulji A, Lonn E |title=Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade |journal=Can J Cardiol |volume=15 |issue=11 |pages=1251–5 |date=November 1999 |pmid=10579740 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Acute myocardial infarction]]
* [[Aortic dissection]]
* [[Aortic rupture]]
* [[Myocardial rupture]]
* [[Ventricular aneurysm|Rupture of ventricular aneurysm]]
* [[Uremic pericarditis]]
* [[Rheumatic fever|Rheumatic pericarditis]]
* [[Tuberculous pericarditis]]
* [[Uremic pericarditis]]
* [[Pericarditis|Viral pericarditis]]
* [[Dressler's syndrome]]
* [[Cardiac catheterization]]
* [[Cardiomyopathy]]
* [[Chemotherapy]]
* [[Chest trauma]]
* [[Collagen vascular disease]]
* [[Congestive heart failure]]
* [[Neoplasm]]
* [[Postpericardiotomy syndrome]]
* [[Radiation injury|Postirradiation]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
* The positional change affecting the [[chest pain]]
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
* [[Orthopnea]]
* '''Anterior:''' [[Anatomical terms of location|Posterior]] boundaries of the [[Anterior mediastinum|prevascular compartment]]
* [[Fever]]
* '''Posterior:''' [[Vertical direction|Vertical]] line connecting a point on each [[Thoracic vertebrae|thoracic]] [[Body of vertebra|vertebral body]] 1 cm [[Anatomical terms of location|posterior]] to its origin
* [[Symptom|symptoms]] of [[infection]], [[injury]] or systemic disease causing the [[Pericardial effusion|effusion]]
| style="background: #F5F5F5; padding: 5px;" |'''Non vascular:'''
* [[Trachea]]
* [[Carina of trachea|Carina]]
* [[Esophagus]]
* [[Lymph node|Lymph nodes]]
'''Vascular:'''
* [[Heart]]
* [[Ascending aorta|Ascending thoracic aorta]]
* [[Aortic arch]]
* [[Descending aorta|Descending thoracic aorta]]
* [[Superior vena cava]]
* [[Pulmonary arteries|Intrapericardial pulmonary arteries]]
* [[Thoracic duct]]


*
*
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Echocardiography]]  guided [[pericardiocentesis]]:
* [[Therapy|Therapeutic]]
* [[Diagnostic]]
* [[Pericarditis|pericardial disease]]
* [[Hemodynamic]] parameters
* Volume
* Effusion content
([[blood]]/[[exudate]]/[[transudate]])
* [[Microbial culture]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Pericard effusion.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/8694 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Physical exam|Physical findings]]:
* [[Pulsus paradoxus]]
* [[Hypotension]] in [[cardiac tamponade]]
* [[Jugular venous distension]] with a prominent Y descent
* [[Kussmaul's sign]]
[[The electrocardiogram|EKG]]:
* [[Electrical alternans]]
[[Echocardiography]]:
* Presence of [[Pericardial effusion|effusion]]
* Reversal of [[Right atrium|RA]] and [[Right ventricle|RV]] [[Diastole|diastolic]] transmural pressures
* [[Heart|Cardiac chamber]] indentation or [[Collapse (medical)|collapse]]
* [[Respiratory]] variation of [[Heart valve|atrioventricular valves]] increased
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Aortic dissection]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Paravertebral'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid15121626">{{cite journal| author=Weissmann-Brenner A, Schoen R, Divon MY| title=Aortic dissection in pregnancy. | journal=Obstet Gynecol | year= 2004 | volume= 103 | issue= 5 Pt 2 | pages= 1110-3 | pmid=15121626 | doi=10.1097/01.AOG.0000124984.82336.43 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15121626  }}</ref><ref name="pmid22829842">{{cite journal| author=Brooke V, Goswami S, Mohanty A, Kasi PM| title=Aortic dissection and renal failure in a patient with severe hypothyroidism. | journal=Case Rep Med | year= 2012 | volume= 2012 | issue=  | pages= 842562 | pmid=22829842 | doi=10.1155/2012/842562 | pmc=PMC3399550 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22829842  }}</ref><ref name="pmid2062514">{{cite journal| author=| title=Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group. | journal=Ophthalmology | year= 1991 | volume= 98 | issue= 5 Suppl | pages= 807-22 | pmid=2062514 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2062514  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Atherosclerosis]]
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
*[[Chest trauma]]
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
 
* '''Anterior:''' [[Anatomical terms of location|Posterior]] boundaries of the [[Middle mediastinum|visceral compartment]]
* [[Chronic hypertension]]
* '''Posterolateral:''' Vertical line against the [[Anatomical terms of location|posterior]] margin of the [[Thoracic cavity|chest wall]] at the [[lateral]] margin of the [[Transverse processes|transverse process]] of the [[Thoracic vertebrae|thoracic spine]]
* [[Iatrogenic|Complication of cardiac procedures]]
 
*[[Connective tissue disorders]]
*[[Vasculitis]]
*Advanced age
*[[Smoking]]  
*[[Lipoprotein disorders|Dyslipidaemia]]
*[[Cocaine]]
*[[Connective tissue disease|Connective tissue disorders]]  
 
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Severe acute [[chest pain]]
* [[Thoracic vertebrae|Thoracic spine]]
* [[Back pain]]
* [[Prevertebral muscles|Paravertebral soft tissues]]
* [[Pain]] radiating to [[Neck stiffness/pain|neck]], [[throat]], [[Jaw pain/swelling|jaw]], and/or unilateral [[Facial pain|face]]
 
* [[Abdominal pain]]
* [[Claudication]]
* [[Hemoptysis]]
* [[Horner syndrome]]
* [[Oliguria]]/ [[Anuria]]
* [[Paraplegia]], [[paralysis]]
* [[Hoarseness]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |[[Magnetic resonance imaging|MRI]]:
* Location of the [[Intima|intimal]] tear
* Involvement of branches of [[aorta]]
* Other [[vascular]] [[pathology]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Aortic dissection GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/25350 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Transesophageal echocardiography (TEE)|TEE]]:
* Identify true and [[False lumen|false lumens]]
* [[Intima|Intimal]] flap
* [[Thrombosis]] in the [[false lumen]]
* [[Pericardial effusion]]
* [[AI|Aortic regurgitation]]
* [[Proximal]] [[Coronary artery|coronaries]]
[[CT angiography|CTA]]:
* Beak sign: An [[acute]] angle between the dissection flap and the [[Artery|arterial]] wall
* Aortic cobwebs: Fibroelastic bands
* Size: [[False lumen]] larger than the true [[lumen]]
* Displaced [[Intima|intimal]] [[calcification]]: True lumen
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Superior vena cava obstruction]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid16502166">{{cite journal |vauthors=Uberoi R |title=Quality assurance guidelines for superior vena cava stenting in malignant disease |journal=Cardiovasc Intervent Radiol |volume=29 |issue=3 |pages=319–22 |year=2006 |pmid=16502166 |doi=10.1007/s00270-005-0284-9 |url=}}</ref><ref name="pmid22477372">{{cite journal |vauthors=Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N |title=Superior vena cava syndrome: A medical emergency? |journal=Int. J. Angiol. |volume=17 |issue=1 |pages=43–6 |date=2008 |pmid=22477372 |doi= |url=}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |Compression of [[SVC]] from:
* [[Aortic aneurysm]]
* [[Bronchogenic carcinoma]]
* [[Breast cancer]]
* [[Cystic hygroma]]
* [[Goiter]]
* [[Histoplasmosis]]
* [[Central venous catheter|Indwelling catheter]]
* [[Lung cancer]]
* [[Lymphoma]]
* [[Non Hodgkin's lymphoma]]
* [[Small cell lung cancer]]
* [[Thymoma]]
* [[Tuberculosis]]
 
| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]]
 
* [[Hoarseness]]
* [[Chest pain]]
* Problems [[swallowing]] and/or talking
* [[Hemoptysis]]
* [[Headache]]
* [[Lightheadedness|Dizziness]]
* [[Decreased alertness]]
* [[Dizziness]]
* [[Fainting]]
* Sensation of [[Headache|head]] or [[ear]] "fullness"
* [[Visual disturbance|Vision changes]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | ++
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|Contrast-enhanced CT scan:]]
* Location and severity of the [[obstruction]]
* Superimposed [[thrombosis]]
* Mediastinal mass or [[lymphadenopathy]]
* Collateral vessels and associated [[Lung mass|lung masses]]
*
| style="background: #F5F5F5; padding: 5px;" |[[File:SVC obstruction GIF.gif|x200px|thumb| CT scan showing a large right upper lobe mass abuts the right brachiocephalic vein and SVC. Case courtesy of Dr Henry Knipe  (Picture courtesy: [https://radiopaedia.org/cases/28046 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |Invasive [[contrast]] [[venography]]:
* [[Superior vena cava syndrome causes|Etiology of obstruction]]
* Exact location of the obstruction
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Partial anomalous pulmonary venous connection]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid22837866">{{cite journal |vauthors=Sears EH, Aliotta JM, Klinger JR |title=Partial anomalous pulmonary venous return presenting with adult-onset pulmonary hypertension |journal=Pulm Circ |volume=2 |issue=2 |pages=250–5 |date=2012 |pmid=22837866 |pmc=3401879 |doi=10.4103/2045-8932.97637 |url=}}</ref><ref name="pmid18595412">{{cite journal |vauthors=Broy C, Bennett S |title=Partial anomalous pulmonary venous return |journal=Mil Med |volume=173 |issue=6 |pages=523–4 |date=June 2008 |pmid=18595412 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Uncommon [[congenital abnormality]]
* Associated with an [[Atrial septal defect|ASD]]
* [[Turner's syndrome|Turner's syndrome (monosomy X)]]
* [[scimitar syndrome|The scimitar syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Asymptomatic]]
* [[dizziness|Exertional dizziness]]
* [[Neck pain]]
* [[Diaphoresis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Magnetic resonance imaging|MRI with contrast]]:
* Provide better [[Anatomical|anatomic]] definition
* Associated defects
* Condition of [[Heart chamber|heart chambers]]
| style="background: #F5F5F5; padding: 5px;" |[[File:TAPVR GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/53955 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |Associated with
* Adult onset [[Pulmonary hypertension|pulmonary arterial hypertension (PAH)]]
* [[Right heart failure|Right ventricular volume overload]] ([[Right heart failure|RV failure)]]
[[Cardiac catheterization|Cardiac catheter]]:
* Pressure and [[Oxygen saturation|O2 Sat]] in [[Heart chamber|heart chambers]]
[[Spirometry|PFT]]:
* Normal despite of severe [[Dyspnea|SOB]]
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Gastrointestinal tract disease'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal achalasia|'''Esophageal achalasia''']]
<ref name="pmid22532812">{{cite journal |vauthors=Gockel I, Müller M, Schumacher J |title=Achalasia--a disease of unknown cause that is often diagnosed too late |journal=Dtsch Arztebl Int |volume=109 |issue=12 |pages=209–14 |year=2012 |pmid=22532812 |pmc=3329145 |doi=10.3238/arztebl.2012.0209 |url=}}</ref><ref name="pmid22791940">{{cite journal |vauthors=Ghoshal UC, Daschakraborty SB, Singh R |title=Pathogenesis of achalasia cardia |journal=World J. Gastroenterol. |volume=18 |issue=24 |pages=3050–7 |year=2012 |pmid=22791940 |pmc=3386318 |doi=10.3748/wjg.v18.i24.3050 |url=}}</ref><ref name="pmid26087861">{{cite journal |vauthors=Ates F, Vaezi MF |title=The Pathogenesis and Management of Achalasia: Current Status and Future Directions |journal=Gut Liver |volume=9 |issue=4 |pages=449–63 |year=2015 |pmid=26087861 |pmc=4477988 |doi=10.5009/gnl14446 |url=}}</ref><ref name="pmid23871090">{{cite journal| author=Boeckxstaens GE, Zaninotto G, Richter JE| title=Achalasia. | journal=Lancet | year= 2013 | volume=  | issue=  | pages=  | pmid=23871090 | doi=10.1016/S0140-6736(13)60651-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23871090  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Idiopathic]]
*[[Chagas disease ]]
 
*[[Gastric carcinoma]]
*[[Herpes zoster]]
*[[HSV-1]]
*[[Measles virus]]
*[[Paraneoplastic syndrome]]
*[[Sarcoidosis ]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysphagia]] for solids and liquids
* [[Regurgitation]] of undigested food
* [[Cough]]
* [[Aspiration]]
* [[Weight loss]]
* [[Chest pain]], radiate to the [[Back pain|back]], [[Jaw pain|jaw]], [[Neck pain|neck]], and [[Arm pain|arms]]
* [[Heartburn]]
* [[Hiccup]]
* Difficulty [[Burping|belching]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[High resolution manometry|High resolution manometry (HRM)]]:
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Incomplete relaxation of the [[Lower esophageal sphincter|LES]]
* Increased resting tone of [[Lower esophageal sphincter|LES]]
* [[Aperistalsis]]
* High intra-esophageal pressure (due to stasis of food)
| style="background: #F5F5F5; padding: 5px;" |[[File:Achalasia- GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/8831 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[X-rays|X ray]]:
* "Bird's beak image" or "rat tail" appearance
* Dilated esophageal body
* Air fluid level due to absent [[peristalsis]]
* Absence of gastric air bubble
* In advanced [[achalasia]] - sigmoid appearance
[[Computed tomography|CT scan]]:
* Dilatation of the [[esophagus]]
* Air fluid levels
* Exclude [[pseudoachalasia]]
* [[Achalasia]] symptoms resulting from [[esophageal cancer]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal cancer|'''Esophageal cancer''']]
<ref>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 [http://www.cancer.gov/cancertopics/pdq/prevention/esophageal/healthprofessional#Section_57 NCI - "Esophageal Cancer (PDQ®): Prevention"].</ref><ref>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</ref><ref>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</ref><ref>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</ref><ref>NCI [http://www.cancer.gov/cancertopics/pdq/prevention/esophageal/healthprofessional#Section_57 Prevention: Dietary Factors], based on Chainani-Wu N. Diet and oral, pharyngeal, and esophageal cancer. ''Nutr Cancer'' 2002;44:104-26. PMID 12734057.</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Age over 60
* Male gender
* [[Smoking]]
* [[Alcohol]] consumption
* [[Obesity]]
* [[Lye]] Ingestion
* [[Nitrosamine]] in food
* [[Plummer-Vinson syndrome]]
* [[Tylosis]] or [[Howel-Evans syndrome]]
* [[Radiation therapy]]
* [[Gastroesophageal reflux disease|GERD]]
* [[Barrett's esophagus]]
* [[Achalasia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Dysphagia]] to solid food
* [[Heartburn]]
* [[Weight loss]]
* Changes in diet
* [[Anorexia]]
 
* [[Regurgitation (digestion)|Regurgitation]] of food or [[saliva]]
* [[Dysphonia|Hoarseness]] or [[Voice disturbances|loss of voice]]
* Intractable [[cough]]
* [[Melena|Blood in stools]]
* Frequent [[pneumonia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy]] with [[biopsy]]:
* Friable lesion
* Superficial [[Plaque|plaques]]
* Superficial [[Nodule (medicine)|nodules]]
* Superficial [[Ulcer|ulcerations]]
* [[Stenosis|Strictures]]
* [[Ulcer|Ulcerated]] [[Tumor|mass]]
* Circumferential [[Tumor|masses]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Esophageal ca GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/29336 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Esophagogram|Barium swallow]]:
* Tapering stricture known as a "rat's tail"
* [[Stenosis|Irregular stricture]]
* Pre-stricture dilatation
* Shouldering
[[Computed tomography|CT scan]]:
* Eccentric or circumferential wall thickening >5 mm
* Peri-[[esophageal]] [[soft tissue]] and [[fat]] stranding
* Dilated fluid and debris filling the esophageal lumen
* [[Tracheobronchial tree|Tracheobronchial]] invasion
* [[Aorta|Aortic]] invasion
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Esophageal rupture|'''Esophageal rupture''']]
<ref name="pmid1994204">{{cite journal |vauthors=McGovern M, Egerton MJ |title=Spontaneous perforation of the cervical oesophagus |journal=Med. J. Aust. |volume=154 |issue=4 |pages=277–8 |year=1991 |pmid=1994204 |doi= |url=}}</ref><ref name="pmid5112482">{{cite journal |vauthors=Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R |title=Spontaneous perforation of the esophagus |journal=Ann. Thorac. Surg. |volume=12 |issue=3 |pages=291–6 |year=1971 |pmid=5112482 |doi= |url=}}</ref>
 
<ref name="pmid3753071">{{cite journal |vauthors=Bladergroen MR, Lowe JE, Postlethwait RW |title=Diagnosis and recommended management of esophageal perforation and rupture |journal=Ann. Thorac. Surg. |volume=42 |issue=3 |pages=235–9 |year=1986 |pmid=3753071 |doi= |url=}}</ref><ref name="pmid7089304">{{cite journal |vauthors=Dodds WJ, Stewart ET, Vlymen WJ |title=Appropriate contrast media for evaluation of esophageal disruption |journal=Radiology |volume=144 |issue=2 |pages=439–41 |year=1982 |pmid=7089304 |doi=10.1148/radiology.144.2.7089304 |url=}}</ref><ref name="pmid1126592">{{cite journal |vauthors=James AE, Montali RJ, Chaffee V, Strecker EP, Vessal K |title=Barium or gastrografin: which contrast media for diagnosis of esophageal tears? |journal=Gastroenterology |volume=68 |issue=5 Pt 1 |pages=1103–13 |year=1975 |pmid=1126592 |doi= |url=}}</ref><ref name="pmid1193339">{{cite journal |vauthors=Schwartz SS |title=Letter: Barium or gastrografin: which contrast media for diagnosis of esophageal tears? |journal=Gastroenterology |volume=69 |issue=6 |pages=1377 |year=1975 |pmid=1193339 |doi= |url=}}</ref><ref name="pmid1115308">{{cite journal |vauthors=Vessal K, Montali RJ, Larson SM, Chaffee V, James AE |title=Evaluation of barium and gastrografin as contrast media for the diagnosis of esophageal ruptures or perforations |journal=Am J Roentgenol Radium Ther Nucl Med |volume=123 |issue=2 |pages=307–19 |year=1975 |pmid=1115308 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Seizures]]
 
* Severe straining
* [[Vomiting]]
 
* [[Childbirth]]
* Prolonged [[coughing]] or laughing
| style="background: #F5F5F5; padding: 5px;" |
[[Mackler's triad]]:
* [[Chest pain]]
* [[Vomiting]]
* [[Subcutaneous emphysema]]
Other:
* [[Odynophagia]]
* [[Fever]]
* [[Tachypnea]]
* [[Tachycardia]]
* [[Cyanosis]], and [[hypotension]]
* [[Pleural effusion]]
Patients with [[cervical]] perforations can present with
* Neck pain
* [[Dysphonia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Esophagogram]]:
* The location
* Extent of [[perforation]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Esophageal perforation GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/26240 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]:
* Esophageal wall [[edema]] and thickening
* Peri-esophageal fluid
* [[Mediastinal widening]]
* Air and fluid in the [[Pleural space|pleural spaces]], [[retroperitoneum]], or [[lesser sac]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hiatus hernia|'''Hiatus hernia''']]
<ref name="pmid22320417">{{cite journal |vauthors=Khajanchee YS, Cassera MA, Swanström LL, Dunst CM |title=Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy |journal=Dis. Esophagus |volume=26 |issue=1 |pages=1–6 |date=January 2013 |pmid=22320417 |doi=10.1111/j.1442-2050.2011.01314.x |url=}}</ref><ref name="pmid24503366">{{cite journal| author=Chang P, Friedenberg F| title=Obesity and GERD. | journal=Gastroenterol Clin North Am | year= 2014 | volume= 43 | issue= 1 | pages= 161-73 | pmid=24503366 | doi=10.1016/j.gtc.2013.11.009 | pmc=3920303 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24503366  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 50 or older age
 
* [[Obesity]]
* Female > Male
 
* [[Trauma]]: when undergoing [[surgery]]
* Frequent [[coughing]]
* Straining with [[constipation]]
* Heavy lifting
* [[Congenital]]
* [[Tobacco smoking|Smoking]]
* [[Stress (medicine)|Stress]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Nausea]]
* [[Vomiting]]
* [[Regurgitation]]
 
* [[Heart burn]]
* [[Regurgitation]]
* [[Dysphagia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[High resolution manometry]] with [[Esophageal pressure topography|esophageal pressure topography (EPT)]]:
* Evidence of separation of the [[Crural hernia|crural]] [[diaphragm]] from the [[lower esophageal sphincter]](LES)
* Real-time localization of the [[gastroesophageal junction]]
* Identification of intermittent [[herniation]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Hiatal hernia GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/59261 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]:
* Location of [[gastroesophageal junction]]
* [[Intestine|Bowel]] diameter measured at the [[Diaphragm (anatomy)|diaphragmatic hiatus]]
[[Ultrasound]] in [[Pediatrics|pediatric]] population:
* Measurement of intra-abdominal [[esophagus]] which is less than 2 cm in diameter
* Sign of a beak at the [[gastroesophageal junction]]
[[Computed tomography|CT scan]]:
* [[Retrocardiac]] air-fluid level
* Organs within the [[Hernia|hernia sac]]
 
* Focal [[fat]] collection in the middle of the [[mediastinum]]
* Visualise contents, length, orientation of [[Hernia|herniated]] [[stomach]] inside the lower [[thorax]]
* Herniated contents lie adjoining to the [[esophagus]]
 
* Widening of [[esophageal hiatus]]
* [[Dehiscence]] of [[Diaphragm (anatomy)|diaphragmatic]] [[crura]] (>15 mm)
 
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" | Pulmonary disease
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hilar lymphadenopathy|'''Hilar lymphadenopathy''']]
<ref name="JashMaji2013">{{cite journal|last1=Jash|first1=Debraj|last2=Maji|first2=Arnab|last3=Patra|first3=Anupam|last4=Sarkar|first4=Supriya|title=Approach to unequal hilum on chest X-ray|journal=The Journal of Association of Chest Physicians|volume=1|issue=2|year=2013|pages=32|issn=2320-8775|doi=10.4103/2320-8775.123204}}</ref><ref name="pmid24753638">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="pmid247536382">{{cite journal |vauthors=Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A |title=Peripheral lymphadenopathy: approach and diagnostic tools |journal=Iran J Med Sci |volume=39 |issue=2 Suppl |pages=158–70 |year=2014 |pmid=24753638 |pmc=3993046 |doi= |url=}}</ref><ref name="radio">Lymph node enlargment. Radiopedia.  http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016</ref>
| style="background: #F5F5F5; padding: 5px;" |[[Lymphadenopathy]]:<nowiki/>
* [[Tuberculosis]]
* [[Tuberculosis|Tubercular]] [[hilar lymphadenopathy]] in adult particularly in [[Immunodeficiency|immunocompromised]] ([[HIV AIDS|HIV infection]])
* [[Lung cancer|Bronchogenic carcinoma]]
* [[Lymphoma]]
* [[Sarcoidosis]]
* [[Infection]] ([[Mycosis|fungal]], [[Nontuberculous mycobacteria|atypical mycobacteria]], [[Virus|viral]], [[tularemia]], and [[anthrax]])
* Exposure to [[silica]] and certain [[:Category:Drugs|drugs]]
| style="background: #F5F5F5; padding: 5px;" |Constituitional symptoms like:
*[[Fatigue]]
*[[Fever]]
*[[Malaise]]
*[[Flu]]-like illness
*[[Nausea]] and [[vomiting]]
*[[Night sweats]]
*[[Weight loss]] and
*[[Cachexia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Lymph node biopsy]] and [[histopathology]]
 
| style="background: #F5F5F5; padding: 5px;" |[[File:Hilar lymphadenopathy GIF.gif|x200px|thumb| CT scan shows bi-hilar lymphadenopathy and reticulonodular infiltrates. Case courtesy of Dr Ruslan Asadov (Picture courtesy: [https://radiopaedia.org/cases/7628 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
* 10 mm in short-axis
* Loss of fatty hilum
* Focal [[necrosis]]
* [[Lymphangioma|Cystic]] [[necrotic]] [[Lymph node|nodes]]
* Long-to-short axis ratio (>2cm - usually [[benign]])
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pneumomediastinum|'''Pneumomediastinum''']]
<ref name="pmid17669882">{{cite journal |author=Utsumi T, Shiono H, Fukai I, Akashi A |title=Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum |journal=Interactive cardiovascular and thoracic surgery |volume=6 |issue=3 |pages=411–2 |year=2007 |pmid=17669882 |doi=10.1510/icvts.2006.147355}}</ref><ref>name="pmid18721592">{{cite journal |vauthors=Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE |title=Spontaneous pneumomediastinum: a comparative study and review of the literature |journal=Ann. Thorac. Surg. |volume=86 |issue=3 |pages=962–6 |date=September 2008 |pmid=18721592 |doi=10.1016/j.athoracsur.2008.04.067 |url=}}</ref><ref name="KimYoo2016">{{cite journal|last1=Kim|first1=Hye Rin|last2=Yoo|first2=Seung Min|last3=Lee|first3=Hwa Yeon|last4=Han|first4=Jin Hee|last5=Frazier|first5=Aletta A|last6=White|first6=Charles S|title=Presence of subpleural pulmonary interstitial emphysema as an indication of single or multiple alveolar ruptures on CT in patients with spontaneous pneumomediastinum|journal=Acta Radiologica|volume=57|issue=12|year=2016|pages=1483–1489|issn=0284-1851|doi=10.1177/0284185116629830}}</ref><ref>{{cite journal|doi=10.3978/j.issn.2072-1439.2015.01.11}}</ref><ref name="pmid15997870">{{cite journal |vauthors=Chiu CY, Wong KS, Yao TC, Huang JL |title=Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children |journal=Asian Pac. J. Allergy Immunol. |volume=23 |issue=1 |pages=19–22 |date=March 2005 |pmid=15997870 |doi= |url=}}</ref><ref name="pmid19411438">{{cite journal |vauthors=Iyer VN, Joshi AY, Ryu JH |title=Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients |journal=Mayo Clin. Proc. |volume=84 |issue=5 |pages=417–21 |date=May 2009 |pmid=19411438 |pmc=2676124 |doi=10.1016/S0025-6196(11)60560-0 |url=}}</ref><ref name="DionísioMartins2017">{{cite journal|last1=Dionísio|first1=Patrícia|last2=Martins|first2=Luís|last3=Moreira|first3=Susana|last4=Manique|first4=Alda|last5=Macedo|first5=Rita|last6=Caeiro|first6=Fátima|last7=Boal|first7=Luísa|last8=Bárbara|first8=Cristina|title=Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years|journal=Jornal Brasileiro de Pneumologia|volume=43|issue=2|year=2017|pages=101–105|issn=1806-3756|doi=10.1590/s1806-37562016000000052}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Endoscopy|Endoscopic procedures]]
*[[Intubation|Intubation/extubation]]
*Central vascular access procedure
*[[Pleural cavity]] instrumentation
*[[Thoracic surgery|Chest]] or [[abdominal surgery]]
*Direct [[Chest trauma|chest wall trauma]]
*[[Tracheostomy]]
*[[Barotrauma|Pulmonary]] [[barotrauma]] (scuba diver, free diver, airplane passenger)
*
| style="background: #F5F5F5; padding: 5px;" |
* Severe, [[Acute chest pain|acute pain in the chest]] (pain may radiate to the [[Shoulder|shoulders]] or [[Back pain|back]])
* [[Dyspnea|Shortness of breath]]
* [[Fever]]
* [[Neck pain|Cervical pain]] ([[Subcutaneous emphysema]])
* [[Jaw pain/swelling|Jaw pain]] ([[Subcutaneous emphysema]])
* [[Neck pain|Swelling of neck]], [[Swollen face|face]], [[chest]], [[abdomen]], [[shoulder]] [[Subcutaneous emphysema|(subcutaneous emphysema]])
* [[Dysphonia]]
* [[Dysphagia]]
* [[Nausea and vomiting|Emesis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]:
* [[Subcutaneous emphysema]]
* Naclerio V sign: [[Pneumomediastinum]] secondary to an [[Boerhaave syndrome|esophageal rupture]]
* [[Pneumopericardium]]: Gas anterior to [[pericardium]]
* Ring around [[artery]] sign: Gas around [[Pulmonary artery|pulmonary artery and main branches]]
* Tubular [[artery]] sign: Gas outlining major [[Aorta|aortic branches]]
* Double bronchial wall sign: Gas outlining [[Bronchus|bronchial wall]]
* Continuous [[Diaphragm (anatomy)|diaphragm]] sign: Gas trapped posterior to [[pericardium]]
* Extrapleural sign: Gas between [[parietal pleura]] and [[Thoracic diaphragm|diaphragm]]
* Gas in [[pulmonary ligament]]
Pediatric [[pneumomediastinum]]:
* Thymic wing sign: Elevated [[thymus]]
* Haystack sign (the [[heart]] appears like a haystack in a Monet painting)
| style="background: #F5F5F5; padding: 5px;" |[[File:PneumomediastinumGIF.gif|x200px|thumb| CT scan shows extensipneumomediastiumium is demonstrated throughout the chest with no pneumothorax. Case courtesy of A.Prof Frank Gaillard
Picture courtesy: [https://radiopaedia.org/cases/18967 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Physical exam:]]
*[[Hamman's crunch|Mediastinal crunch]] or click on [[auscultation]] over the [[Apex of the heart|cardiac apex]] and the [[left sternal border]] synchronous with the [[Heart sounds|heart sound]] [[Hamman's sign|(Hamman's sign)]]
*[[Subcutaneous emphysema physical examination|Subcutaneous crepitation]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sarcoidosis|'''Sarcoidosis''']]
<ref name="sar">Teirstein AS, Judson MA, Baughman RP, et al: The spectrum of biopsy sites for the diagnosis of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 22(2):139 146, 2005.</ref><ref>Judson MA, Boan AD, Lackland DT: The clinical course of sarcoidosis: presentation, diagnosis, and treatment in a large white and black cohort in the United States. Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG 2012, 29(2):119-127.</ref><ref>Roberts SD, Mirowski GW, Wilkes D, Kwo PY, Knox KS: Sarcoidosis. Part II: extrapulmonary and systemic manifestations. Journal of the American Academy of Dermatology 2004, 51(4):628-630.</ref><ref>Lieberman J, Nosal A, Schlessner A, Sastre-Foken A: Serum angiotensin-converting enzyme for diagnosis and therapeutic evaluation of sarcoidosis. Am Rev Respir Dis 120(2):329–335, 1979.</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[African american race]]
* People of Scandinavian descent
* Exposure to [[Dust|dusty]]/[[Mold|moldy]] environments
* People between 25 and 40 years
[[Genetics|Genetic factors]]
* The first-degree relatives have 55 fold increased the risk
* [[HLA-DRB1|HLA-DRB1*1101]] is associated with [[cardiac sarcoidosis]] and [[hypercalcemia]]
* [[Löfgren syndrome|Lofgren's syndrome]], [[HLA-DRB1|HLA-DRB1*03]] is 4 times higher
* [[BTNL2|BTNL-2 (butyrophilin-like 2)]] gene
Immune system
* Higher expression of [[serum amyloid A]]
* Immune system exhaustion and failure of effective antigen clearence
[[Adverse effect (medicine)|Drug side effect]]
* [[Adalimumab]]
* [[Etanercept]]
* [[Ipilimumab]]
* [[Infliximab]]
| style="background: #F5F5F5; padding: 5px;" |[[Sarcoidosis classification|Cutaneous sarcoidosis]]
* [[Papule|Papular]], [[Nodular lesions|nodular]], [[Plaque|plaque-like]], [[lupus pernio]], [[erythema nodosum]], [[Subcutaneous tissue|subcutaneous]] [[sarcoidosis]]
[[Sarcoidosis classification|Ocular sarcoidosis]]
* [[dry eye]], [[blurred vision]], [[photophobia]], [[red eye]], [[Eye pain|pain]]
[[Upper respiratory tract]]
* [[Cough]]
* [[Nasal congestion]]
* Nasal crusting
* [[anosmia]]
* [[epistaxis]]
* [[Nasal polyp|Nasal polyposis]]
[[Sarcoidosis classification|Cardiac sarcoidosis]]
* [[Palpitation|Palpitations]]
* [[syncope]]
* [[lightheadedness]]
* [[chest pain]]
* [[sudden cardiac death]] ([[SCD]])
[[Neurosarcoidosis]]
* [[facial nerve palsy|Peripheral facial nerve palsy]]
* [[Polyuria]] - [[polydipsia]]
* Disturbance in [[Thermoregulation|body temperature]] and [[libido]] due to [[Encephalitis|hypothalamic inflammation]]
* [[Seizure|Seizures]]
* [[Sleep disturbance|Impairment in sleep]]
[[Reticuloendothelial system]]
* [[Neck masses|Neck]] or [[Axillary lymph nodes|axillary mass]]
* [[Lymphadenopathy]]
* [[Hepatosplenomegaly]]
[[Musculocutaneous]]
* Acute [[Sarcoidosis|sarcoid arthritis]] or [[Polyarthritis|acute polyarthritis]]
* [[Arthritis|Chronic arthritis]]
* [[Myositis classification|Myopathy(diffuse granulomatous myositis)]]
[[Löfgren syndrome|Lofgren syndrome]]
* [[erythema nodosum]]
* [[hilar lymphadenopathy]]
* [[Polyarthralgia|Migratory polyarthralgia]]
* [[fever]]
[[Exocrine gland|Exocrine glands]]
* Painless [[Swelling (medical)|swelling]] of [[salivary glands]] and [[parotid gland]]
* [[Sicca syndrome]] and [[xerostomia]]
Renal & electrolyte
* [[Renal colic]] caused by [[nephrolithiasis]]
* [[Uremia, acute|Uremia]] due to [[interstitial nephritis]]
*
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopy]] with [[biopsy]] and [[histopathology]]
* [[Granuloma|Granulomas]] can be detected in any organ
| style="background: #F5F5F5; padding: 5px;" |[[File:Sarcoidosis lung.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/34388 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Laboratory]] findings:
* [[Angiotensin-converting enzyme|Serum ACE]] levels greater than two times the upper limit of normal
[[Computed tomography|CT scan]]:
* Honeycombing
* parenchymal [[Nodule (medicine)|nodules]] and opacities along bronchovascular bundles as well as in subpleural locations
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Infectious disease'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mediastinitis|'''Mediastinitis''']]
<ref name="pmid23351519">{{cite journal| author=Martínez Vallina P, Espinosa Jiménez D, Hernández Pérez L, Triviño Ramírez A| title=[Mediastinitis]. | journal=Arch Bronconeumol | year= 2011 | volume= 47 Suppl 8 | issue=  | pages= 32-6 | pmid=23351519 | doi=10.1016/S0300-2896(11)70065-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23351519  }}</ref><ref name="pmid26336443">{{cite journal| author=Lewandowski B, Pakla P, Wołek W, Jednakiewicz M, Nicpoń J| title=A fatal case of descending necrotizing mediastinitis as a complication of odontogenic infection. A case report. | journal=Kardiochir Torakochirurgia Pol | year= 2014 | volume= 11 | issue= 3 | pages= 324-8 | pmid=26336443 | doi=10.5114/kitp.2014.45685 | pmc=PMC4283893 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26336443  }}</ref><ref>Symptoms of mediastinitis. Right Diagnosis (2015). http://www.rightdiagnosis.com/m/mediastinitis/symptoms.htm Accessed on September 28, 2015</ref><ref name="EEE">Mediastinitis: parotid abscess complication. Brazilian Journal of Otorhinolaryngology (2013). http://www.scielo.br/scielo.php?pid=S1808-86942014000300268&script=sci_arttext Accessed on September 28, 2015</ref>
| style="background: #F5F5F5; padding: 5px;" |
[[Infection]]:
*[[Group A beta-hemolytic streptococci]]
*''[[Streptococcus milleri]]''
*''[[Mycobacterium tuberculosis]]''
*''[[Histoplasma capsulatum]]''
*''[[Bacillus anthracis]]''
*''[[Candida albicans]]''
Risk factors:
* [[Thoracic surgery|Recent chest surgery]]
* [[Endoscopy]]
* [[Obesity]]
* [[Smoking]]
* [[Immunodeficiency]]
* [[Intensive care unit]] stay > 2 days
* [[COPD]]
* [[Intravenous drug use|Drug users]]
* [[Diabetes]]
* [[Renal insufficiency|Kidney failure]]
* [[Peripheral arterial disease|Peripheral vascular disease]]
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
* [[Cough]]
* [[Chills]]
* [[Fever]]
* [[Malaise]]
* [[Abdominal pain]]
* [[Hemoptysis]]
* [[Tachycardia]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Growth medium|Culture]] and [[sensitivity]] of [[Mediastinal|mediastinal tissue]] collected by [[biopsy]]/[[Aspiration (medicine)|aspiration]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Sarcoidosis 01.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/34388 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |Physical exam
*[[Chest wall]] tenderness
*Wound drainage
*Unstable [[chest wall]]
[[Complete blood count|CBC]]
* [[Leukocytosis]]
[[Computed tomography|CT scan]]
* [[Mediastinal lymph node|Mediastinal]] or [[Hilar lymphadenopathy|hilar mass]]
* Infiltrative region of soft-tissue attenuation which obliterates normal mediastinal fat planes and encases or invades adjacent structures
* [[Calcification|Calcifications]] of the central [[Tumor|mass]] or associated [[Lymph node|lymph nodes]] (especially if there has been preceding [[histoplasmosis]])
* [[Tracheobronchial]] narrowing
* [[Pulmonary]] infiltrates
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Anthrax|'''Anthrax''']]
<ref name="urlSymptoms | Anthrax | CDC">{{cite web |url=https://www.cdc.gov/anthrax/basics/symptoms.html |title=Symptoms &#124; Anthrax &#124; CDC |format= |work= |accessdate=}}</ref><ref name="WHO">{{cite web | title = Anthrax in Humans and Animals | url = http://www.who.int/csr/resources/publications/anthrax_web.pdf }}</ref>
| style="background: #F5F5F5; padding: 5px;" |''[[Bacillus anthracis|B. anthracis]]''
People at higher [[Risk factor|risk]]
* Veterinarians
* Laboratory professionals dealing the [[bacteria]]
* Health care workers
* Livestock producers
* People who handle animal products
* Mail handlers, military personnel, and response workers, in case of bioterrorism
* People who make or play animal hide drums
* Travelers, particularly to the follow areas:
** Central and South America
** Sub-Saharan Africa
** Central and southwestern Asia
** Southern and eastern Europe
** The Caribbean
*
| style="background: #F5F5F5; padding: 5px;" |
[[Inhalation anthrax|Inhalation]] or [[Inhalation anthrax|pulmonary anthrax]]
* [[Fatigue]]
* [[Body aches|Body pain]]
* [[Fever]] and [[chills]]
* [[Sweating]]
* [[Headache]]
* [[Confusion]] or [[dizziness]]
* [[Sore throat]]
* [[Cough]]
* [[Chest discomfort]]
* [[Shortness of breath]]
* [[Nausea]]
* [[Vomiting]]
* [[Stomach pain|Stomach pains]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Culture medium|Culture]] and sensitivity:
* [[Serum]]
* [[Blood plasma|Plasma]]
* [[Blood]]
* [[Pleural effusion|Pleural fluid]]
* [[CSF]]
* [[Biopsy|Biopsy specimen]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Antrax GIF.gif|x200px|thumb| CT scan shows showing bilateral pulmonary consolidation (yellow arrows) and pleural effusions (blue arrows). Case courtesy and picture courtesy: [https://wwwnc.cdc.gov/eid/article/7/6/01-0604-f4 Centers for Disease Control and Prevention]]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
* [[Mediastinal widening]]
* Hyperdense [[lymph nodes]] in the [[mediastinum]]
* Lymph  node [[hemorrhage]] and [[necrosis]] following [[spore|spore germination]] and [[Vegetation (pathology)|vegetative growth]] with [[exotoxin]] elaboration
* [[Edema]] of [[mediastinal]] fat
[[Polymerase chain reaction|PCR]]
* Confirms [[virulence]] of [[Bacillus anthracis|organism]] by [[virulence factor]] [[genes]]
 
* [[Primers]] to the [[toxin]] [[gene]]
 
* [[Primer]] for the [[enzyme]] of [[capsule]] formation [[gene]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Tuberculosis]]'''
<ref name="CDC">{{cite web | title = Tuberculosis Fact Sheet | url = http://www.cdc.gov/tb/publications/factsheets/drtb/mdrtb.htm }}</ref><ref name="Griffith_1996">{{cite journal |author=Griffith D, Kerr C |title=Tuberculosis: disease of the past, disease of the present |journal=J Perianesth Nurs |volume=11 |issue=4 |pages=240-5 |year=1996 | pmid = 8964016}}</ref>
| style="background: #F5F5F5; padding: 5px;" |''[[Mycobacterium tuberculosis|M. tuberculosis]]''
 
Traveling or living in endemic regions (Sub-saharan African, Russia, India, Pakistan, China)
* Elderly
* Infants
* [[Intravenous drug use (recreational)|IV drug users]]
[[Immunosuppression]]:
* [[AIDS]]
* [[Diabetes]]
* [[Silicosis]]
* [[Malignancy]], such as [[Head and neck cancer|head and neck cancers]]
 
* [[Hematology|Hematologic]] and [[Reticuloendothelial system|reticuloendothelial disease]]
* [[End-stage kidney disease]]
* History of [[gastrectomy]]
* [[Malabsorption syndrome]]
The risk of contracting [[TB]] increases in:
* Frequent contact with people who have [[TB]]
* [[Nutritional deficiencies|Poor nutrition]]
* [[Smoking]]
* Bad hygiene
| style="background: #F5F5F5; padding: 5px;" |
* [[Cough]] (most common)
 
* [[Fever]]
* [[Night sweats]]
* Unexplained [[weight loss]]
* [[Hemoptysis]]
* [[Chest pain]]
* [[Anorexia]]
* [[Malaise]]
* [[Chills]]
* [[Fatigue]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |Culture and sensitivity
| style="background: #F5F5F5; padding: 5px;" |[[File:Pulm TB GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/9095 Radiopedia])]]
*
| style="background: #F5F5F5; padding: 5px;" |[[Chest X-ray]]
 
[[Tuberculosis, pulmonary|Primary Tuberculosis]]
* [[Parenchyma|Parenchymal]] [[infiltrates]]
* [[Hilar lymphadenopathy|Hiliar adenopathy]]
* [[pleural effusion]]
* [[Tuberculosis|Tuberculomas]] (opacities similar to a [[lung mass]])
* Unilateral [[pleural effusion]] may be observed
[[Tuberculosis|Secondary Tuberculosis]]
* The most common location upper lobes, specially in the apical and posterior segment
* Patchy consolidation
* [[Cavitation]], which is the most important finding in [[Tuberculosis|secondary tuberculosis]]
** Irregular margins and thick walls
** Seen in the upper [[lung]]
** [[Cavity|Cavities]] may be [[Superinfection|superinfected]]
** An air-fluid level is seen
* [[Pneumothorax]] is rare
* [[Lymphadenopathy]]
* Small [[pleural effusion]]
 
* Consolidation involves more than one lobe
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Cystic mass'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Bronchogenic cyst]]'''
<ref name="pmid23225215" />
| style="background: #F5F5F5; padding: 5px;" |
* Abnormal [[ventral]] budding or branching of the [[tracheobronchial tree]] during [[Embryology|embryologic]] development
| style="background: #F5F5F5; padding: 5px;" |
* [[Pleurisy|Pleuritic chest pain]]
* [[Cough]]
* [[Hemoptysis]]
* [[Fever]]
* [[Pneumonia]] secondary to [[airway obstruction]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Bronchogenic cyst GIF.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/10946 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan:]]
* Spherical or oval [[Tumor|mass]]
* Smooth outline
* Unilocular
* Noncalcified
* Demonstrating the size and shape of the [[cyst]]
* Determining its position in relation to other structures
* [[Bronchogenic cyst|Bronchogenic cysts]] can mimic [[Echinococcosis|hydatid cysts]]
* [[Pneumonitis]], [[pneumothorax]], or [[empyema]] may present
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Enteric duplication cysts|Esophageal duplication cysts]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="pmid25184121">{{cite journal |vauthors=Liu R, Adler DG |title=Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound |journal=Endosc Ultrasound |volume=3 |issue=3 |pages=152–60 |date=July 2014 |pmid=25184121 |pmc=4145475 |doi=10.4103/2303-9027.138783 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Rare [[Congenital malformations|congenital gastrointestinal malformation]]
 
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Chest pain]]
* [[Stridor]]
* [[Cough|Nonproductive cough]]
* [[Epigastric distress|Epigastric discomfort]]
* [[Vomiting]]
* [[Cardiac arrhythmia]]
* [[Retrosternal]] and [[thoracic]] [[back pain]]
* [[Cyst]] [[ulceration]] and [[bleeding]]
* [[Cyst]] [[rupture]] with secondary [[mediastinitis]]
 
*
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopic ultrasound|Endoscopic ultrasound (EUS)]]
* Distinguish between solid and [[Cyst|cystic]] lesions
* Periesophageal [[homogeneous]]-hypoechoic mass
* Multi-layered wall and well-defined margins
* [[Anechoic]] [[cyst]] if considerable central fluid present
*
| style="background: #F5F5F5; padding: 5px;" |[[File:Foregut duplication cyst.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/10641 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Endoscopic ultrasound]]-guided [[Needle aspiration biopsy|FNA]]
* Atypical in appearance for [[Enteric duplication cysts|duplication cysts]]
* [[Cancer|Malignancy]] suspicion
[[Endoscopy]]
* Indistinguishable from a [[lipoma]], [[leiomyoma]], a [[gastrointestinal stromal tumor|gastrointestinal stromal tumor (GIST)]], or other [[Submucosal|submucosal lesions]]
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lymphangioma]]'''
<ref name="pmid23225215" /><ref name="pmid3706240">{{cite journal |vauthors=Carr RF, Ochs RH, Ritter DA, Kenny JD, Fridey JL, Ming PM |title=Fetal cystic hygroma and Turner's syndrome |journal=Am. J. Dis. Child. |volume=140 |issue=6 |pages=580–3 |date=June 1986 |pmid=3706240 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Turner syndrome]]
* [[Down syndrome]]
* [[Noonan syndrome]]
* [[Chronic (medical)|Chronic]] [[lymphatic obstruction]] such as after [[surgery]], [[Infection|infections]] or [[radiotherapy]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Constipation]]
* [[Failure to thrive]]
* Signs and symptoms of [[Genetic disorder|genetic defects]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Histopathology]] and [[Cell biology|cytology]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Mediastinal lymohangioma GIF.gif|x200px|thumb| CT scan shows cystic mass which was located on the posterior to the lower esophagus later diagnosed as thoracic duct lymphangioma. [https://doi.org/10.5090/kjtcs.2014.47.4.423 Source:Case courtesy of Jin San Bok et al, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital]]]
| style="background: #F5F5F5; padding: 5px;" |
[[Magnetic resonance imaging|MRI:]]
* Degree of involvement and extent of lesion
* [[Magnetic resonance imaging|MRI]] can prevent extensive, incomplete surgical resection
[[Computed tomography|CT scan]]:
* [[Homogenization|Homogeneous]], [[cystic]] [[Tumor|mass]]
* Intrinsic [[Septa|septations]]
* Compression of adjacent organs
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Chronic inflammatory disease'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Churg-Strauss syndrome|'''Churg-Strauss syndrome''']]
<ref name="pmid14740430">{{cite journal |vauthors=Hellmich B, Ehlers S, Csernok E, Gross WL |title=Update on the pathogenesis of Churg-Strauss syndrome |journal=Clin. Exp. Rheumatol. |volume=21 |issue=6 Suppl 32 |pages=S69–77 |date=2003 |pmid=14740430 |doi= |url=}}</ref><ref name="pmid29240526">{{cite journal |vauthors=Safran T, Masckauchan M, Maj J, Green L |title=Wells syndrome secondary to influenza vaccination: A case report and review of the literature |journal=Hum Vaccin Immunother |volume= |issue= |pages=1–3 |date=December 2017 |pmid=29240526 |doi=10.1080/21645515.2017.1417714 |url=}}</ref><ref name="pmid20623310">{{cite journal |vauthors=Szczeklik W, Sokołowska B, Mastalerz L, Grzanka P, Górka J, Pacułt K, Miszalski-Jamka T, Soja J, Musiał J |title=Pulmonary findings in Churg-Strauss syndrome in chest X-rays and high resolution computed tomography at the time of initial diagnosis |journal=Clin. Rheumatol. |volume=29 |issue=10 |pages=1127–34 |date=October 2010 |pmid=20623310 |doi=10.1007/s10067-010-1530-3 |url=}}</ref><ref name="pmid15818205">{{cite journal |vauthors=Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A |title=Churg-Strauss syndrome: high resolution CT and pathologic findings |journal=J Thorac Imaging |volume=20 |issue=2 |pages=74–80 |date=May 2005 |pmid=15818205 |doi= |url=}}</ref><ref name="pmid21496416">{{cite journal |vauthors=Feng RE, Xu WB, Shi JH, Mahmoudi A, Mu WB, Zheng WJ, Zhu YJ, Liu HR |title=Pathological and high resolution CT findings in Churg-Strauss syndrome |journal=Chin. Med. Sci. J. |volume=26 |issue=1 |pages=1–8 |date=March 2011 |pmid=21496416 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[HLA-DRB1|HLA-DRB1*04]] and [[HLA-DRB1|*07]]
* [[HLA DRB4|HLA - DRB4]]
* [[Allergen|Allergens]]
* [[Infection|Infections]]
* [[Vaccination|Vaccinations]] (eg, [[influenza]])
* [[:Category:Drugs|Drugs]]:
** [[Leukotriene antagonist|Leukotriene receptor antagonists]]/ [[Montelukast|leukotriene modifying agents]]
** [[Omalizumab|Anti IgE antibodies]] (eg, [[omalizumab]])
** [[Mesalazine]]
** [[Propylthiouracil]]
** [[Methimazole]]
** [[Silica|Exposure to silica]]
** [[Cocaine]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Chest tightness]]
*[[Cough]]
*[[Hemoptysis]]
*[[Asthma]]
 
*[[Muscle weakness|Weakness]]
*[[Malaise]]
*[[Fever]]
*[[Weight loss]]
*[[Arthralgia]]
*[[Fatigue]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Lung]] [[biopsy]]
 
4 out of 6 positive :
* [[Asthma]]
* [[Eosinophilia]]
* [[Polyneuropathy]] or [[Mononeuropathy]]
* Non fixed pulmonary infiltrates
* [[Paranasal sinus]] that is abnormal
* [[Eosinophil granulocyte|Eosinophils]] that are extravascular
| style="background: #F5F5F5; padding: 5px;" |[[File:Eosinophilic granulomatosis with polyangiitis.gif|x200px|thumb| 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: [https://radiopaedia.org/cases/63621 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |
[[High-resolution CT|High-resolution computerized tomography]] ([[High Resolution CT|HRCT]]):
* [[Alveolar lung disease|Airspace]] consolidations mostly bilateral and [[Lobe (anatomy)|lobular]]
* [[Ground glass opacification on CT|Ground-glass opacities]] in a patchy or [[subpleural]] distribution
* [[Centrilobular]] [[Nodule (medicine)|nodules]]
* [[Bronchial|Bronchial wall]] thickening and/or dilatation
* [[Pleural effusion|Pleural effusions]]
* [[Hilum|Hilar]] or [[mediastinal lymph node]] enlargement
* Interlobular septal thickening
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
|-
! colspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Posterior mediastinal mass
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |'''Cystic mass'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Mediastinal neuroenteric cyst|Mediastinal neurenteric cyst]]'''
<ref name="pmid23225215" /><ref name="SettyHegde2005">{{cite journal|last1=Setty|first1=HAN|last2=Hegde|first2=KKS|last3=Narvekar|first3=VN|title=Neurenteric cyst of the posterior mediastinum|journal=Australasian Radiology|volume=49|issue=2|year=2005|pages=151–153|issn=0004-8461|doi=10.1111/j.1440-1673.2005.01360.x}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Developmental abnormality|Developmental foregut anomaly]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Neurological disorder|Neurologic impairment]]
** [[Back pain]]
** [[Gait abnormality|Gait disturbance]]
** [[Sensory|Sensory deficit]]
** [[Motor neuron disease|Motor deficit]]
* [[Stridor]]
* [[Cough|Persistent cough]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]:
* [[Cyst|Cystic]] nature of the [[Tumor|mass]]
* Extent of the [[Tumor|mass]]
* [[Congenital anomalies of spine|Vertebral anomalies]]
 
| style="background: #F5F5F5; padding: 5px;" |[[File:Neurenteric Cyst new GIF.gif|x200px|thumb| 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). [https://10.21699/ajcr.v7i4.454 Source: Case courtesy of Taruna Yadav et al]]]
| style="background: #F5F5F5; padding: 5px;" |[[Postnatal]] [[chest X-ray]]:
* [[Posterior mediastinum|Posterior mediastinal]] [[Tumor|mass]] with associated [[Congenital anomalies of spine|vertebral anomalies]]
[[Ultrasound]]:
* [[Cyst|Cystic]] nature of the [[Tumor|mass]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Pancreatic pseudocyst]]'''
<ref name="pmid23225215" /><ref name="EltaEnestvedt2018">{{cite journal|last1=Elta|first1=Grace H|last2=Enestvedt|first2=Brintha K|last3=Sauer|first3=Bryan G|last4=Marie Lennon|first4=Anne|title=ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts|journal=The American Journal of Gastroenterology|volume=113|issue=4|year=2018|pages=464–479|issn=0002-9270|doi=10.1038/ajg.2018.14}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Acute pancreatitis]]
* [[Chronic pancreatitis]]
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Abdominal pain]] - constant [[Abdominal pain|pain]] or deep [[Abdominal pain|ache in the abdomen]]
* [[Back pain|Pain radiating to the back]]
* [[Abdominal mass]]
* [[Bloating|Bloating of the abdomen]]
* Difficulty eating
* [[Indigestion]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Histopathology]] and [[Cell biology|cytology]] of [[cyst]] and fluid content
| style="background: #F5F5F5; padding: 5px;" |[[File:Mediastinal pancreatic pseudocyst.gif|x200px|thumb| 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:[https://radiopaedia.org/cases/40011 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Computed tomography|CT scan]]
* Thin-walled
* Fluid-containing [[cyst]] within the [[posterior mediastinum]]
* In continuity with the intrapancreatic or peripancreatic fluid collections
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Disease'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Etiology'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dyspnea/'''
RI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Dysphagia'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''SVCS'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Image'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Additional findings'''
|-
! colspan="9" style="background: #707070; color: #FFFFFF; text-align: center;" |Central nervous system disease
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Meningocele]]'''
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="urlWhat is Spina Bifida | CDC">{{cite web |url=https://www.cdc.gov/ncbddd/spinabifida/facts.html#ca |title=What is Spina Bifida &#124; CDC |format= |work= |accessdate=}}</ref><ref name="pmid14758561">{{cite journal |vauthors=Edwards RJ, Witchell C, Pople IK |title=Chronic headaches in adults with spina bifida and associated hydrocephalus |journal=Eur J Pediatr Surg |volume=13 Suppl 1 |issue= |pages=S13–7 |date=December 2003 |pmid=14758561 |doi=10.1055/s-2003-44751 |url=}}</ref><ref name="pmid2997126">{{cite journal |vauthors=Duncan BK |title=Isolation of insertion, deletion, and nonsense mutations of the uracil-DNA glycosylase (ung) gene of Escherichia coli K-12 |journal=J. Bacteriol. |volume=164 |issue=2 |pages=689–95 |date=November 1985 |pmid=2997126 |doi= |url=}}</ref><ref name="pmid4067977">{{cite journal |vauthors=Flenley DC |title=Disordered breathing during sleep: discussion paper |journal=J R Soc Med |volume=78 |issue=12 |pages=1031–3 |date=December 1985 |pmid=4067977 |doi=10.1177/014107688507801211 |url=}}</ref><ref name="pmid15555669">{{cite journal |vauthors=Mitchell LE, Adzick NS, Melchionne J, Pasquariello PS, Sutton LN, Whitehead AS |title=Spina bifida |journal=Lancet |volume=364 |issue=9448 |pages=1885–95 |date=2004 |pmid=15555669 |doi=10.1016/S0140-6736(04)17445-X |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
Congenial defect:
 
Maternal nutrition factors:
* [[Alcohol abuse|Alcohol use]]
* [[Caffeine]] use
* [[Folate deficiency|Low folate intake]]
* Elevated glycaemic load or index
* Low [[methionine]] intake
* Low serum [[choline]] level
* [[Vitamin B12 deficiency|Low serum vitamin B12 level]]
* [[Vitamin C deficiency|Low vitamin C level]]
* [[Zinc deficiency|Low zinc intake]]
* [[Smoking]]
* [[Hyperthermia]]
* [[Perinatal infection|Maternal infections]] and illnesses
* [[diabetes|Pregestational insulin-dependent diabetes]]
* [[obesity|Pregestational obesity]]
* [[Psychosocial|Psychosocial stress]]
* [[Valproic acid]] use
2. Environmental factors:
* [[Air pollution|Ambient air pollution]]
* Disinfectant by-products in drinking water
* [[Air pollution|Indoor air pollution]]
* Nitrate-related compounds
* [[Solvent|Organic solvents]]
* [[Pesticides]]
* [[Polycyclic aromatic hydrocarbons]]
| style="background: #F5F5F5; padding: 5px;" |Symptoms depend on the severity of the defect
* [[Muscle weakness|Weakness]] or [[paralysis]] in the legs
* [[Urinary incontinence]]
* [[Bowel]] incontinence
* [[Sensation]] problems in the [[lower extremity]]
* [[Motor skills disorder|Motor problems in the lower extremity]]
* [[Headache]]
[[Orthopedic|Orthopedic abnormalities]]:
* [[Club foot]]
* [[Hip dislocation]]
* [[Scoliosis]]
Difficulties with executive functions including:
* [[Planning]]
* Organizing
* Initiating
* [[Memory]]
* [[Abstraction]]
* [[Attention|Attention problems]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Prenatal]] 2D/3D [[ultrasound]]:
* [[Vertebral anomalies|Vertebral defect]]
* Splayed [[Vertebral|vertebral pedicles]]
* Disrupted [[vertebrae]]
[[Postnatal]] [[Magnetic resonance imaging|MRI]]
 
| style="background: #F5F5F5; padding: 5px;" |[[File:Giant-thoracic-meningocoele-GIF.gif|x200px|thumb| CT scan showing Right thoracic CSF cyst with smaller left sided out-pouching. Case courtesy of Dr G Balachandran (Picture courtesy: [https://radiopaedia.org/cases/10384 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Laboratory techniques|Laboratory tests:]]
* Elevated Maternal Serum [[Alpha-fetoprotein|Alpha-Fetoprotein]]
[[Magnetic resonance imaging|MRI]]:
* [[Herniation]] of a [[CSF]] filled sac through [[spina bifida]]
* [[CSF]] attenuation lesion in [[conus medullaris]] and other parts of the [[CNS]]
* Short and thick [[filum terminale]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Neurilemmoma]]'''
([[Schwannoma|Spinal schwannoma]])
 
<ref name="pmid23225215">{{cite journal |vauthors=Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L |title=A diagnostic approach to the mediastinal masses |journal=Insights Imaging |volume=4 |issue=1 |pages=29–52 |date=February 2013 |pmid=23225215 |doi=10.1007/s13244-012-0201-0 |url=}}</ref><ref name="urlSchwannoma | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/4767/schwannoma |title=Schwannoma &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Neurofibromatosis type II]]
* [[Schwannomatosis]]
* [[Carney complex]]
| style="background: #F5F5F5; padding: 5px;" |
* Sharp, aching, or burning [[pain]]
* [[Paresthesia|Pins-and-needles sensation]]
* [[Muscle weakness]]
* [[Paresthesia|Numbness]]
* Nighttime [[Back pain|pain in back]] or [[Neck stiffness/pain|neck]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] with [[histopathology]]
| style="background: #F5F5F5; padding: 5px;" |[[File:Posterior-mediastinal-schwannoma.gif|x200px|thumb| 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:[https://radiopaedia.org/cases/26625 Radiopedia])]]
| style="background: #F5F5F5; padding: 5px;" |[[Magnetic resonance imaging|MRI]]
* [[Tumor]] outside of a [[nerve]] or part of a [[nerve]] and if it involves other nearby structures
|-
| colspan="9" |'''<small>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</small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small><small><nowiki/></small>, '''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</small>
|-
|-
| colspan="3" style="background:#DCDCDC;" align="left" + |<small>'''Adapted from [https://doi.org/10.1148/rg.2017160095 Radiographics]'''</small>
|}
|}
===Causes in Alphabetical Order<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>===
*[[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>
*[[Aortic dissection]]
*[[Bronchogenic cyst]]
*[[Churg-Strauss syndrome]]
*[[Dermoid cyst]]
*[[Esophageal achalasia]]
*[[Esophageal cancer]]
*[[Esophageal rupture]]
*[[Goitre]]
*[[Hiatus hernia]]
*[[Hilar lymphadenopathy]]
*[[Lymphoma]]
*[[Mediastinal germ cell tumor]]
*[[Mediastinal tumor]]
*[[Mediastinitis]]
*[[Neurilemmoma]]
*[[Non-Hodgkin lymphoma]]
*[[Partial anomalous pulmonary venous connection]]
*[[Pericardial effusion]]
*[[Pneumomediastinum]]
*[[Sarcoidosis]]
*[[Superior vena cava obstruction]]
*Supine AP [[chest x ray]] can yield a false positive "widened mediastinum": 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.
*[[Teratoma]]
*[[Thymoma]]
*[[Thyroid cancer]]
*[[Tuberculosis]]


==References==
==References==

Latest revision as of 16:43, 12 March 2019

Mediastinal mass Microchapters

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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]

Synonyms and keywords: Mediastinal enlargement; mass in the mediastinum

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. The mediastinum lies between the right and left pleura in and near the median sagittal plane of the chest. It extends from the sternum in front to the vertebral column behind, and contains all the thoracic viscera except the lungs. On the basis of cross-sectional imaging, mediastinum can be divided into 3 groups: 1) Prevascular compartment: which contains thymus, fat, lymph nodes and left brachiocephalic vein. 2) Visceral compartment, which contains trachea, carina, esophagus, lymph nodes, heart, ascending thoracic aorta, aortic arch, descending thoracic aorta, superior vena cava, intrapericardial pulmonary arteries, and thoracic duct. and 3) Paravertebral compartment: which contains the thoracic spine and paravertebral tissue. A wide variety of diseases involving these organs can 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. A mediastinal mass may cause a variety of symptoms by the mass pressing against other mediastinal structures, collectively known as mediastinal syndrome. Mediastinal mass can be differentiated according to the content of the mass such as cystic mass, fatty mass or solid (tumor). Depending on location and composition of the mass further diagnosis is made by specific imaging studies, endoscopic studies, tissue biopsies, histopathological studies and/or growth of microorganism on specific culture medium.

Anatomy of mediastinum

  • Note that clinical radiologists and anatomists categorize the mediastinum in slightly different ways.
International Thymic Malignancy Interest Group (ITMIG) Classification of Mediastinum
Compartments Boundaries Components
Prevascular
Visceral Non vascular:

Vascular:

Paravertebral
Adapted from Radiographics

References

  1. ↑ Carter, Brett W.; Benveniste, Marcelo F.; Madan, Rachna; Godoy, Myrna C.; de Groot, Patricia M.; Truong, Mylene T.; Rosado-de-Christenson, Melissa L.; Marom, Edith M. (2017). "ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses". RadioGraphics. 37 (2): 413–436. doi:10.1148/rg.2017160095. ISSN 0271-5333.
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