Mediastinal mass

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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], Amr Marawan, M.D. [3]

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. Different types of mediastinal masses can be encountered in various imaging techniques causing pressure symptoms or even without causing any symptoms. Mediastinal masses can be differentiated on the basis of location in the mediastinal cavity and/or composition of the mass.

Causes

Following can appear as a mediastinal mass on imaging studies:

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

Causes by Organ System

Cardiovascular
Chemical / poisoning No underlying causes
Dermatologic Dermoid cyst
Drug Side Effect No underlying causes
Ear Nose Throat
Endocrine
  • Goitre, when more than 50% of the mass is located below the thoracic inlet, is termed intrathoracic goitre[46] which appear as mediastinal mass.
  • Thyroid cancer
Environmental Intrathoracic goitre
Gastroenterologic
Genetic No underlying causes
Hematologic
Iatrogenic Mediastinitis
Infectious Disease
Musculoskeletal / Ortho No underlying causes
Neurologic Mediastinal neurilemmoma may originate from right phrenic nerve[54], intrathoracic vagal nerve[55]
Nutritional / Metabolic Intrathoracic goitre
Obstetric/Gynecologic No underlying causes
Oncologic
Opthalmologic No underlying causes
Overdose / Toxicity Inhaled recreational drugs such as cocaine which induced bronschospasm, increased alveolar pressure followed by alveolar rupture leading to interstitial emphysema and pneumomediastinum[56].
Psychiatric No underlying causes
Pulmonary
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy
Sexual No underlying causes
Trauma
Urologic No underlying causes
Miscellaneous
  • 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".

Causes in Alphabetical Order

References

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  2. ↑ Sears EH, Aliotta JM, Klinger JR (2012). "Partial anomalous pulmonary venous return presenting with adult-onset pulmonary hypertension". Pulm Circ. 2 (2): 250–5. doi:10.4103/2045-8932.97637. PMC 3401879. PMID 22837866.
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  4. ↑ Vanneman MW, Fikry K, Quraishi SA, Schoenfeld W (August 2015). "A Young Man with a Mediastinal Mass and Sudden Cardiac Arrest". Ann Am Thorac Soc. 12 (8): 1235–9. doi:10.1513/AnnalsATS.201504-212CC. PMID 26317273.
  5. ↑ Salem K, Mulji A, Lonn E (November 1999). "Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade". Can J Cardiol. 15 (11): 1251–5. PMID 10579740.
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  36. ↑ No TH, Seol SH, Seo GW, Kim DI, Yang SY, Jeong CH, Hwang YH, Kim JY (September 2015). "Benign Mature Teratoma in Anterior Mediastinum". J Clin Med Res. 7 (9): 726–8. doi:10.14740/jocmr2270w. PMC 4522994. PMID 26251691.
  37. ↑ Molinari F, Bankier AA, Eisenberg RL (November 2011). "Fat-containing lesions in adult thoracic imaging". AJR Am J Roentgenol. 197 (5): W795–813. doi:10.2214/AJR.11.6932. PMID 22021525.
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  39. ↑ Setty, HAN; Hegde, KKS; Narvekar, VN (2005). "Neurenteric cyst of the posterior mediastinum". Australasian Radiology. 49 (2): 151–153. doi:10.1111/j.1440-1673.2005.01360.x. ISSN 0004-8461.
  40. ↑ Elta, Grace H; Enestvedt, Brintha K; Sauer, Bryan G; Marie Lennon, Anne (2018). "ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts". The American Journal of Gastroenterology. 113 (4): 464–479. doi:10.1038/ajg.2018.14. ISSN 0002-9270.
  41. ↑ Kondov, Goran; Kondov, Borislav; Srceva, Marija Jovanovska; Damjanovski, Goge; Ferati, Imran; Karapetrov, Ivan; Topuzovska, Irena Kondova; Tanevska, Nikolina; Kokareva, Anita (2017). "Giant Mediastinal Thymic Cyst". PRILOZI. 38 (2): 139–145. doi:10.1515/prilozi-2017-0032. ISSN 1857-8985.
  42. ↑ Symptoms of mediastinitis. Right Diagnosis (2015). http://www.rightdiagnosis.com/m/mediastinitis/symptoms.htm Accessed on September 28, 2015
  43. ↑ 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
  44. ↑ Silva CI, Müller NL, Fujimoto K, Johkoh T, Ajzen SA, Churg A (May 2005). "Churg-Strauss syndrome: high resolution CT and pathologic findings". J Thorac Imaging. 20 (2): 74–80. PMID 15818205.
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  48. ↑ 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.
  49. ↑ 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.
  50. ↑ Estrera AS, Landay MJ, Grisham JM, Sinn DP, Platt MR. Descending necrotizing mediastinitis. Surg Gynecol Obstet 1983;157:545-52.
  51. ↑ Alsoub H, Chacko KC. Descending necrotising mediastinitis. Postgrad Med J 1995;71:98-101.
  52. ↑ Sakamoto H, Aoki T, Kise Y, Watanabe D, Sasaki J (2000). "Descending necrotizing mediastinitis due to odontogenic infections". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 89 (4): 412–9. PMID 10760723.
  53. ↑ 53.0 53.1 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.
  54. ↑ Hirose H, Ohmori K, Nakaoka Y, Kitamura K, Muramatsu T, Namiki Y; et al. (1998). "[Mediastinal neurilemmoma originating in the right phrenic nerve: a case report]". Nihon Kokyuki Gakkai Zasshi. 36 (12): 1027–31. PMID 10064956.
  55. ↑ Ito I, Komota K, Nakajima T, Ishibashi K, Kawazoe K (1994). "[A case of mediastinal neurilemmoma originating from the intrathoracic vagal nerve]". Kyobu Geka. 47 (4): 325–7. PMID 8152184.
  56. ↑ Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF (1992). "Spontaneous pneumomediastinum: clinical and natural history". Ann Emerg Med. 21 (10): 1222–7. PMID 1416301.
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