Sandbox:Trusha: Difference between revisions

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Revision as of 18:45, 15 February 2019

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

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CT scan shows cystic mass which was located on the posterior to the lower esophagus later diagnosed as thoracic duct lymphangioma. Source:Case courtesy of Jin San Bok et al, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital

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:Radiopedia)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[4], Amr Marawan, M.D. [5]

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

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

@@ Line 36: / Line 36: @@
-[[File:Hodgkin's disease ant mediastinum GIF.gif|x300px|thumb| 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
+[[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]]]
-(Picture courtesy: [https://radiopaedia.org/cases/24432 Radiopedia])]]
-[[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])]]
+[[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])]]
@@ Line 56: / Line 58: @@
 ==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==

Sandbox:Trusha: Difference between revisions

Revision as of 18:45, 15 February 2019

new

Overview

Causes

Initial Evaluation

References

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