Mediastinal Masses Flashcards
What are the boundaries of the mediastinum?
Superiorly -> thoracic inlet Inferiorly -> diaphragm Anteriorly -> sternum Posteriorly -> spine Laterally -> pleural spaces
What does the anterior compartment of the mediastinum contain?
- thymus
- internal mammary vessels
- lower pole of thyroid
- ectopic thyroid
- lymph nodes
What are the components of the posterior compartment of the mediastinum (paraventral sulcus)?
- sympathetic chain
- proximal portion of intercostal neurovascular bundles
- thoracic spinal ganglia
- azygous vein & lymph nodes & fat
What are the components of the middle compartment (visceral) of the mediastinum?
- great vessels
- heart
- pericardium
- trachea
- proximal main stem bronchi
- vagus nerves
- phrenic nerves
- esophagus
- thoracic duct
- descending aorta
- azygous venous system
What are the tumors of the mediastinum?
4Ts
- thymic -> thymoma - thymic cyst
- lymphoma -> terrible lymphoma - Hodgkin & non Hodgkin)
- germ cell -> teratoma
- thyroid -> goiter - carcinoma
What are the common tumors in the visceral (middle) compartment?
- forgut cysts -> bronchogenic - esophageal - gastric
- tracheal & esophageal tumors
- primary or secondary tumors of lymph nodes
- lymphoma
What are the common tumors occurring in the paravertebral sulci (posterior)?
- neurogenic -> neurofibroma - shwannoma
- vascular
- mesenchymal
- lymphatic
What are the tumors occurring in the anterior compartment?
- thymoma
- lymphoma
- seminoma (alpha fetoprotein)
- carcinoma
- cystic masses: thymic cyst - pericardial cyst
- bronchogenic cyst
- teratoma
What are the most common tumors of the mediastinum in children?
1- neurogenic
2- lymphomas
3- foregut cysts
4- benign germ cell tumors
What is the most common mediastinum tumor in adults?
Thymic tumors
What are the most common presenting complaints in a mediastinal mass?
- chest pain
- cough
- dyspnea
What are the signs of anatomic invasion or compression of a mediastinal mass?
- RLN -> hoarseness of voice
- sympathetic nerve chain -> Horner syndrome
- phrenic nerve -> shortness of breath
- spinal cord -> loss of power/sensation
- heart -> arrhythmia - heart failure
- trachea -> cough - hemoptysis - wheeze - SOB
- esophagus -> dysphagia - hematemesis - Melena
- SVC syndrome
- pericardium & pleura -> chest pain - SOB
- thymoma -> myasthenia gravis
- thymic carcinoma -> Cushing’s syndrome
How should diagnosis of mediastinal mass occur?
CT or MRI then Tissue diagnosis If big mass -> fine needle If small non-invasive -> surgical excision & biopsy
What are the signs seen on X ray suggesting a mass?
- anterior mediastinum: aorta pulmonary window fullness
- middle mediastinum: tracheal displacement
- posterior mediastinum: supraclavicular mass
