Mediastinal mass
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, 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. 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 | |||||||||||||||||||||||||||||||||
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.