Disease of Mediastinum and Pleura Flashcards Preview

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Flashcards in Disease of Mediastinum and Pleura Deck (65)
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1

What are the 3 compartments of the mediastinum?

Anterior (between sternum and pericardial sac)

Middle (from anterior pericardial sac to ventral surface of spine)

Posterior (spine and costovertebral gutters)

2

What resides in the anterior-superior compartment of the mediastinum? (5)

Thymus gland

Aortic root and great vessels

Substernal thyroid and parathyroid tissue

Lymphatic vessels and nodes

Inferior aspect of trachea and esophagus

3

What resides in the middle compartment of the mediastinum? (7)

1. Pericardial sac

2. Heart

3. Innominate veins and SVC

4. Trachea and major bronchi

5. Hila

6. Lymph nodes

7. Phrenic, upper vagus, and recurrent laryngeal nerves

4

What resides in the posterior compartment of the mediastinum?

1. Esophagus

2. Descending aorta

3. Azygous and hemiazygous veins

4. Thoracic duct

5. Lymph nodes

6. Vagus nerves (lower portion)

7. Sympathetic chains

5

Mediastinal masses can be organized in categories of  _____ or _____, and ____ or _____.

Asymptomatic or symptomatic, benign or malignant

6

How are asymptomatic mediastinal masses found?

Incidental finding on imaging

7

What are the local and systemic symptoms of mediastinal masses?

Local symptoms: Compression or invasion of adjacent structures

Systemic symptoms: Fever, anorexia, weight loss (often lymph node related). Endocrine syndromes (thymus related). Autoimmune symptoms (thymus related)

8

____ percent of asymptomatic masses are benign

80%

9

____ percent of symptomatic masses are malignant

50%

10

In terms of mediastinal mass location, what is most common in adults vs. children?

Adults - anterior

Children - posterior

11

Are adults or children more symptomatic when it comes to mediastinal masses?

Children are more symptomatic (66%)

Adults (33%)

12

When evaluating for mediastinal mass, what are symptoms associated with obstructions of contiguous organs?

Dysphagia (compression of esophagus)

Hoarseness (compression of recurrent laryngeal nerve)

SVC syndrome (facial/upper extremity swelling from compression of superior vena cava)

Cough, stridor, hemoptysis, shortness of breath (compression of lungs)

Horner syndrome (sympathetic chain compression resulting in miosis (a constricted pupil), ptosis (a weak, droopy eyelid), apparent anhidrosis (decreased sweating))

13

What are B symptoms that can be seen with mediastinal masses? (3)

- Fevers

- Weight Loss

- Drenching night sweats

14

For mediastinal mass evaluation, what should be checked in physical exams?

- blood pressure

- weight loss

- lymphadenopathy

- Exam of head, neck, upper extremities, and chest

15

What imaging is done when evaluating for mediastinal mass?

CXR (PA and Lateral)

- to localize

CT Chest

- anatomic location

- differentiate between cyst vs solid lesions

- identify fatty structures

- lympadenopathy vs. vascular structures

16

Which compartment is the mediastinal mass in?

Anterior compartment.

17

What's the differential diagnosis for an anterior compartment mediastinal mass? (7)

The 4 Terrible T's is to help you remember the most common differential diagnosis for anterior compartment mediastinal masses.

1. Thymic neoplasm

2. Teratoma (germ cell tumor)

3. (Terrible) Lymphoma (hogkin's disease or non-hodgkin's lymphoma)

4. Thyroid neoplasm

And less commonly:

5. Mesenchymal neoplasm

6. Diaphragmatic hernia (Morgagni)

7. Primary carcinoma

18

Which compartment is the mediastinal mass in?

Middle compartment.

19

20% of middle compartment mediastinal masses are due to ____

cysts

20

What is the differential diagnosis for middle compartment masses? (10)

1. Lymphadenopathy

2. Developmental cysts

3. Reactive and granulomatous inflammation

4. Metastasis (going to lymph nodes)

5. Lymphoma

6. Pericardial Cyst

7. Bronchogenic Cyst

8. Enteric Cyst

9. Vascular Enlargements

10. Diaphragmatic hernia (hiatal)

21

Which compartment is the mediastinal mass in?

Posterior compartment

22

What is the differential diagnosis for posterior compartment mediastinal masses? (9)

1. Peripheral nerve (neurinomas)

2. Neurogenic tumors

3. Sympathetic ganglia

4. Paraganglionic tissue

5. Meningocoele

6. Esophageal lesions

7. Carcinoma

8. Diverticuli

9. Diaphragmatic hernia (Bochdalek)

23

What kind of mass would a CBC with differential help in diagnosing?

Helpful for diagnosing lymphoma

24

What kind of mass would beta-HCG and alpha-fetoprotein help in diagnosing?

B-HCG and a-fetoprotein are markers associated with germ cell tumors (e.g. teratoma)

25

What kind of mass would anti-acetylcholine receptor antibodies lab test be helpful in diagnosing?

Thymoma (thymus tumor)

26

What are 3 needle aspiration techniques that can be used to biopsy a mediastinal mass?

- Transbronchial Needle Aspiration (down the trachea and through the bronchial wall)

- Percutaneous Needle Aspiration (coming from outside of the chest cavity)

- Endoscopic ultrasound guided Aspiration (through esophagus or trachea)

27

What are 2 surgical approaches for obtaining tissue for diagnostic evaluation of mediastinal masses?

- mediastinoscopy (under sternum)

- thoracoscopy (through chest wall)

28

What are 4 complications of mediastinal masses?

- Tracheal obstruction

- SVC syndrome (facial and upper extremity edema)

- Vascular invasion (hemorrhage)

- Esophageal rupture

29

Is the visceral or parietal pleura innervated (and can sense pain)?

Parietal pleura. Patients that have issues with the visceral pleura don't experience pain while patients who have issues with parietal pleura will feel pain.

30

The pleural space is a _____ space between the visceral and parietal pleura

Potential. IRL, the two surfaces are right up against each other but things can get into this space (e.g. air, fluid, masses, etc)