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{{Mediastinal mass}}
{{Mediastinal mass}}


{{CMG}}; {{AE}} {{Trusha}}, {{AM}}
{{CMG}}; {{AE}}{{Trusha}}


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


==Overview==
==Overview==
The [[mediastinum]] is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. It is the central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, esophagus, trachea, thymus, and lymph nodes of the central chest. A wide variety of diseases involving these organs can present as a mediastinal mass or widening of the mediastinum on imaging studies. 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 caused by the mass pressing against other organs or even without any symptoms. Mediastinal masses can be differentiated on the basis of location in the mediastinal cavity into 3 groups: Prevascular, visceral and paravertebral.
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]].


==Causes==
==Anatomy of mediastinum==
Following can appear as a mediastinal mass on imaging studies:
* 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]]. It may be divided for purposes of description into two parts:
** '''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)
** '''Inferior mediastinum''': Below the upper level of the [[pericardium]]. This lower portion is again subdivided into three parts:
*** In front of the pericardium, the [[anterior mediastinum]]
*** Containing the pericardium and its contents, the [[middle mediastinum]]
*** Behind the pericardium, the [[posterior mediastinum]]
*** 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]].
*** It is continuous with the [[loose connective tissue]] of the [[neck]], and extends [[Anatomical terms of location|inferiorly]] into the [[Diaphragm (anatomy)|diaphragm]].
 
* Note that clinical radiologists and anatomists categorize the mediastinum in slightly different ways.
 
* 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>
** [[Anterior mediastinum|Prevascular (anterior)]]
** [[Middle mediastinum|Visceral (middle)]]
** [[Posterior mediastinum|Paravertebral (posterior)]]
{|
{|
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''<big>International Thymic Malignancy Interest Group (ITMIG) Classification of Mediastinum</big>'''
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Cardiovascular causes'''
| style="background: #F5F5F5; padding: 5px;" |
* [[Superior vena cava obstruction]]<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>
* [[Partial anomalous pulmonary venous connection]]<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>
* [[Pericardial effusion]]<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>
* [[Aortic dissection]]<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: #DCDCDC; padding: 5px; text-align: center;" |'''Gastrointestinal causes'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Compartments'''
| style="background: #F5F5F5; padding: 5px;" |
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Boundaries'''
* [[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>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Components'''
* [[Esophageal cancer]]<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>
* [[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>
* [[Enteric duplication cysts|Esophageal duplication cyst]]<ref name="pmid25184121" />
* [[Hiatus hernia]]<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: #DCDCDC; padding: 5px; text-align: center;" |'''Pulmonary causes'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Prevascular'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hilar lymphadenopathy]]<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>
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
* [[Pneumomediastinum]]<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>
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
* [[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>
* '''Anterior:''' [[Sternum]]
* [[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>
* '''Posterior:''' [[Anatomical terms of location|Anterior]] aspect of the [[pericardium]]
* [[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>
* '''Lateral:''' [[Parietal pleura|Parietal mediastinal pleura]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''CNS diseases'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Spina bifida|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="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>
* [[Thymus]]
* [[Neurilemmoma]]<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>
* [[Fat]]
* [[Lymph node|Lymph nodes]]
* [[Brachiocephalic vein|Left brachiocephalic vein]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Thyroid diseases'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Visceral'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Goitre]]<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>
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
|-
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Mediastinal tumors'''
* '''Anterior:''' [[Anatomical terms of location|Posterior]] boundaries of the [[Anterior mediastinum|prevascular compartment]]
| style="background: #F5F5F5; padding: 5px;" |
* '''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
* [[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;" |'''Non vascular:'''
* [[Hodgkin lymphoma]]<ref>{{Cite journal
* [[Trachea]]
| author = [[J. J. Goedert]], [[T. R. Cote]], [[P. Virgo]], [[S. M. Scoppa]], [[D. W. Kingma]], [[M. H. Gail]], [[E. S. Jaffe]] & [[R. J. Biggar]]
* [[Carina of trachea|Carina]]
| title = Spectrum of AIDS-associated malignant disorders
* [[Esophagus]]
| journal = [[Lancet (London, England)]]
* [[Lymph node|Lymph nodes]]
| volume = 351
'''Vascular:'''
| issue = 9119
* [[Heart]]
| pages = 1833–1839
* [[Ascending aorta|Ascending thoracic aorta]]
| year = 1998
* [[Aortic arch]]
| month = June
* [[Descending aorta|Descending thoracic aorta]]
| pmid = 9652666
* [[Superior vena cava]]
}}</ref><ref>{{Cite journal
* [[Pulmonary arteries|Intrapericardial pulmonary arteries]]
| author = [[M. Tinguely]], [[R. Vonlanthen]], [[E. Muller]], [[C. C. Dommann-Scherrer]], [[J. Schneider]], [[J. A. Laissue]] & [[B. Borisch]]
* [[Thoracic duct]]
| 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>
* [[Teratoma]]<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>
* [[Mediastinal germ cell tumor]]<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>
* [[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>
* [[Mediastinal germ cell tumor]]<ref name="pmid23225215" />
* [[Lipoma]]<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>
* [[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: #DCDCDC; padding: 5px; text-align: center;" |'''Cystic mass'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Paravertebral'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[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>
* '''Superior:''' [[Superior thoracic aperture|Thoracic inlet]]
* [[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>
* '''Inferior:''' [[Thoracic diaphragm|Diaphragm]]
* [[Bronchogenic cyst]]<ref name="pmid23225215" />
* '''Anterior:''' [[Anatomical terms of location|Posterior]] boundaries of the [[Middle mediastinum|visceral compartment]]
* [[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>
* '''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]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Other'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Mediastinitis]]<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>
* [[Thoracic vertebrae|Thoracic spine]]
* [[Churg-Strauss syndrome]]<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>
* [[Prevertebral muscles|Paravertebral soft tissues]]
|}
 
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" |
*[[Aortitis]]
*[[Aortic dissection]]
*[[Partial anomalous pulmonary venous connection]]
*[[Pericardial effusion]]
*[[Superior vena cava obstruction]]
|-
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | [[Dermoid cyst]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" |  
*Acute descending necrotizing mediastinitis
*[[Goitre]]
*[[Thyroid cancer]]
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" |
*[[Goitre]], when more than 50% of the mass is located below the thoracic inlet, is termed intrathoracic goitre<ref name="pmid9818814">{{cite journal| author=Netterville JL, Coleman SC, Smith JC, Smith MM, Day TA, Burkey BB| title=Management of substernal goiter. | journal=Laryngoscope | year= 1998 | volume= 108 | issue= 11 Pt 1 | pages= 1611-7 | pmid=9818814 | doi= | pmc= | url= }} </ref> which appear as mediastinal mass.
*[[Thyroid cancer]]
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | Intrathoracic [[goitre]]
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" |
*[[Esophageal achalasia]]
*[[Esophageal cancer]]
*[[Esophageal rupture]] leading to [[pneumomediastinum]] secondary to excessive [[vomiting]].
*[[Hiatus hernia]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" |
*[[Hilar lymphadenopathy]]
*[[Lymphoma]]
*[[Non-Hodgkin lymphoma]]
*[[Thymoma]]
*Mediastinal [[lymphangiomas]]
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Mediastinitis]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" |
*Acute descending necrotizing mediastinitis <ref>MKSAP 11: Medical knowledge self-assessment program. Philadelphia: American College of Physicians, 1998:966-7.</ref> <ref>Corsten MJ, Shamji FM, Odell PF, Frederico JA, Laframboise GG, Reid KR, et al. Optimal treatment of descending necrotising mediastinitis. Thorax 1997;52:702-8. </ref> <ref>Wheatley MJ, Stirling MC, Kirsch MM, Gago O, Orringer MB. Descending necrotizing mediastinitis: transcervical drainage is not enough. Ann Thorac Surg 1990;49:780-4.</ref> <ref>Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545-52. </ref> <ref>Alsoub H, Chacko KC. Descending necrotising mediastinitis. Postgrad Med J 1995;71:98-101.</ref> Dental infections are the cause in 60-70% of the cases<ref name="pmid10760723">{{cite journal| author=Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J| title=Descending necrotizing mediastinitis due to odontogenic infections. | journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod | year= 2000 | volume= 89 | issue= 4 | pages= 412-9 | pmid=10760723 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10760723  }} </ref>. Can also occur secondary to head and neck infections. [[Streptococcus|Hemolytic group streptococci]] and [[Bacteroides]] species are the common organisms.
*[[Anthrax]]- This is a classic finding associated with inhalational [[anthrax]]. A widened mediastinum was found in 7 of the first 10 victims infected by anthrax (''[[Bacillus anthracis]]'') in 2001.<ref name="pmid11747719">{{cite journal |author=Jernigan JA, Stephens DS, Ashford DA, ''et al'' |title=Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States |journal=Emerging Infect. Dis. |volume=7 |issue=6 |pages=933–44 |year=2001 |pmid=11747719 |doi=}}</ref>
*[[Mediastinitis]]
*[[Tularemia]]
*Mediastinal [[abscess]]
*[[Histoplasmosis]]
*[[Psittacosis]]
*[[Tuberculosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | Mediastinal [[neurilemmoma]] may originate from right phrenic nerve<ref name="pmid10064956">{{cite journal| author=Hirose H, Ohmori K, Nakaoka Y, Kitamura K, Muramatsu T, Namiki Y et al.| title=[Mediastinal neurilemmoma originating in the right phrenic nerve: a case report]. | journal=Nihon Kokyuki Gakkai Zasshi | year= 1998 | volume= 36 | issue= 12 | pages= 1027-31 | pmid=10064956 | doi= | pmc= | url= }} </ref>,  intrathoracic vagal nerve<ref name="pmid8152184">{{cite journal| author=Ito I, Komota K, Nakajima T, Ishibashi K, Kawazoe K| title=[A case of mediastinal neurilemmoma originating from the intrathoracic vagal nerve]. | journal=Kyobu Geka | year= 1994 | volume= 47 | issue= 4 | pages= 325-7 | pmid=8152184 | doi= | pmc= | url= }} </ref>
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| bgcolor="Beige" | Intrathoracic [[goitre]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" |
*[[Esophageal cancer]]
*[[Lymphoma]]
*[[Mediastinal germ cell tumor]]
*[[Mediastinal tumor]]
*[[Mediastinal mass]]
*[[Neurilemmoma]]
*[[Non-Hodgkin lymphoma]]
*[[Hodgkins disease]]
*[[Teratoma]]
*[[Thymoma]]
*[[Thyroid cancer]]
* Metastatis to pericardium
|-
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| bgcolor="Beige" | Inhaled recreational drugs such as [[cocaine]] which induced bronschospasm, increased alveolar pressure followed by alveolar rupture leading to [[interstitial emphysema]] and [[pneumomediastinum]]<ref name="pmid1416301">{{cite journal| author=Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF| title=Spontaneous pneumomediastinum: clinical and natural history. | journal=Ann Emerg Med | year= 1992 | volume= 21 | issue= 10 | pages= 1222-7 | pmid=1416301 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1416301  }} </ref>.
*[[silicosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" |
*[[Bronchogenic cyst]]
*[[Pneumomediastinum]] secondary to air leak from any part of the lung or airways into the mediastinum due to excessive coughing, sneezing.
*[[Sarcoidosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| bgcolor="Beige" |
*[[Churg-Strauss syndrome]]
*[[Sarcoidosis]]
*[[Wegener's granulomatosis]]
*[[Erythema nodosum]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" |
*[[Pneumomediastinum]]
*Hemorrhagic [[pericardial effusion]]
*[[Chylopericardium]] refers to a communication between the pericardial sac and the thoracic duct, as a result of trauma
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" |
*[[Dermoid cyst]] is thick-walled and contains various tissue materials of skin, hair, occasionally teeth, and caseous (cheesy) substance. They are usually found in the front of the chest, but rarely are located within the pericardium. If not removed, it may get infected and rupture.
*Supine AP [[chest x ray]] can yield a [[false positive]] "widened mediastinum".
|-
|-
| colspan="3" style="background:#DCDCDC;" align="left" + |<small>'''Adapted from [https://doi.org/10.1148/rg.2017160095 Radiographics]'''</small>
|}
|}
=== Causes in Alphabetical Order ===
*[[Anthrax]]: This is a classic finding associated with inhaled [[anthrax]]. A widened mediastinum was found in 7 of the first 10 victims infected ''Bacillus anthracis'' in 2001.<ref name="pmid11747719">{{cite journal |author=Jernigan JA, Stephens DS, Ashford DA, ''et al'' |title=Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States |journal=Emerging Infect. Dis. |volume=7 |issue=6 |pages=933–44 |year=2001 |pmid=11747719 |doi=}}</ref>
*[[Aortic dissection]]
*[[Bronchogenic cyst]]
*[[Churg-Strauss syndrome]]
*[[Esophageal achalasia]]
*[[Esophageal cancer]]
*[[Esophageal rupture]]
*[[Goitre]]
*[[Hiatus hernia]]
*[[Hilar lymphadenopathy]]
*[[Lymphoma]]
*[[Mediastinal germ cell tumor]]
*[[Mediastinitis]]
*[[Neurilemmoma]]
*[[Non-Hodgkin lymphoma]]
*[[Partial anomalous pulmonary venous connection]]
*[[Pericardial effusion]]
*[[Pneumomediastinum]]
*[[Sarcoidosis]]
*[[Superior vena cava obstruction]]
*[[Teratoma]]
*[[Thymoma]]
*[[Thyroid cancer]]
*[[Tuberculosis]]


==References==
==References==

Latest revision as of 16:43, 12 March 2019

Mediastinal mass Microchapters

Home

Overview

Anatomy of Mediastinum

Causes

Differentiating Mediastinal Mass from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2]

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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