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Revision as of 13:46, 14 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[3]

new

CT scan showing A large soft tissue attenuation mass occupying the anterior mediastinal displaying homogenous attenuation with low-density areas of cystic changes inside. It extends to the middle mediastinum to occupy the pretracheal space and involve the right hilum. Inferiorly it is inseparable from the anterior pericardium. Compression upon the SVC and encasement of the aorta and great vessels are noted. There is also mild right costal pleural thickening and enhancement suggesting infiltration with mild pleural effusion and abdominal retrocaval lymph nodes. Case courtesy of Dr Ahmed Abdrabou (Picture courtesy: Radiopedia)

File:Name

CT scan showing excessive fatty tissue deposition within the posterior mediastinum with anterior displacement of the esophagus. Case courtesy of Dr. Ahmed Abdrabou (Picture courtesy: [1])

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[5], Amr Marawan, M.D. [6]

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. Since it is the central compartment of the thoracic cavity, and it contains a lot of important structures, it is the site of involvement of various tumors.

Causes

Causes in Alphabetical Order^[1]^[2]

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.^[3]
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
Tularemia

Initial Evaluation

Mediastinal Mass

Workups

❑ CT chest with contrast
❑ Serum beta-HCG, AFP, if appropriate
❑ CBC, platelets
❑ PET-CT scan (optional)
❑ Pulmonary function tests if clinically indicated
❑ MRI chest if clinically indicated

Thymic Tumor Likely

Thymic Tumor Unlikely

Consider surgery

Disease-specific management

References

↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
↑ Jernigan JA, Stephens DS, Ashford DA; et al. (2001). "Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States". Emerging Infect. Dis. 7 (6): 933–44. PMID 11747719.

[1] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[2] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[pmid11747719-3] Jernigan JA, Stephens DS, Ashford DA; et al. (2001). "Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States". Emerging Infect. Dis. 7 (6): 933–44. PMID 11747719.

[1]

[2]

[3]

@@ Line 41: / Line 41: @@
 [[File: name|x300px|thumb| CT scan showing excessive fatty tissue deposition within the posterior mediastinum with anterior displacement of the esophagus. Case courtesy of Dr. Ahmed Abdrabou (Picture courtesy: [https://radiopaedia.org/cases/50447Radiopedia])]]
+__NOTOC__
+{{SI}}
+{{CMG}}; {{AE}} {{Trusha}}, {{AM}}
+{{SK}} 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. Since it is the central compartment of the thoracic cavity, and it contains a lot of important structures, it is the site of involvement of various tumors.
+==Causes==
+===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]]
+*[[Tularemia]]
+==Initial Evaluation==
+{{familytree/start}}
+{{Family tree |border=2|boxstyle=background: WhiteSmoke;| | | | | A01 | | | | |A01=<div style="float: left; text-align: center; height: 1.25em; width: 25em; padding: 1em;">'''Mediastinal Mass'''</div>}}
+{{familytree | | | | | |!| | | | | | | | }}
+{{familytree | | | | | B01 | | | |B01=<div style="float: left; text-align: left; line-height: 150%; padding: 1em; "> '''Workups'''
+----
+❑ CT chest with contrast <br> ❑ Serum beta-HCG, AFP, if appropriate <br> ❑ CBC, platelets <br> ❑ PET-CT scan (optional) <br> ❑ Pulmonary function tests if clinically indicated <br> ❑ MRI chest if clinically indicated
+</div>}}
+{{familytree | |,|-|-|-|^|-|-|-|.| | | | | | | }}
+{{familytree | C01 | | | | | | C02 | | | |C01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Likely''' </div> |C02= <div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;">  '''Thymic Tumor Unlikely''' </div>}}
+{{familytree | |!| | | | | | | |!| | | | | }}
+{{familytree | D01 | | | | | | D02 | | | |D01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Consider [[Thymoma surgery|surgery]]</div>|D02=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Disease-specific management</div>}}
+{{familytree/start}}
 ==References==
 {{Reflist|2}}