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| {{CMG}} {{AE}} {{Trusha}} | | {{CMG}} {{AE}} {{Trusha}} |
| | |
| | ==new== |
| | |
| | |
| | |
| | {| align="right" |
| | | |
| | [[Image:Squamous cell mircopathology2.jpeg|x200px|thumb| Micropathology: Squamous cell carcinoma of the lung. H&E stain, By Nephron [https://commons.wikimedia.org/wiki/File%3ALung_squamous_carcinoma_--_high_mag.jpg Wikimedia Commons]]] |
| | |} |
| | {| align="right" |
| | | |
| | [[Image:Bronchial cancer.jpeg|x200px|thumb|Gross pathology: Bronchial squamous lung cell cancer By John Hayman [Public domain], (Image source: [https://commons.wikimedia.org/wiki/File%3ACa_bronchus.jpg Wikimedia Commons])]] |
| | |} |
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| {| | | {| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| |
| | colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| |
| ! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| |
| | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| |
| ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
| |
| |-
| |
| | colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| |
| ! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam
| |
| |-
| |
| ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
| |
| ! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Radiology
| |
| ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
| |
| |-
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cough
| |
| and
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|
| |
|
| Sputum
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hemoptysis
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
| |
| ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Percussion
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Auscultation
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sputum analysis
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nodule
| |
| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Nodule content
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| ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other findings
| |
| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pulmonary nodule|Pulmonary Nodule]](benign)
| |
| | style="background: #F5F5F5; padding: 5px;" |-
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Asymptomatic
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Hyporesonance
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| * Dull percussion
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
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|
| |
|
| * Present [[pleural friction rub]]
| | # [[Superior vena cava obstruction]] |
| * Present [[egophony]]
| | # [[Partial anomalous pulmonary venous connection]] |
| * Crackling or bubbling noises
| | # [[Esophageal achalasia]] |
| * Present whispered pectoriloquy
| | # [[Esophageal cancer]] |
| * Decreased/absent [[breath sounds]]
| | # [[Esophageal rupture]] |
| | style="background: #F5F5F5; padding: 5px;" |
| | # [[Hiatus hernia]] |
| * Normal
| | # [[Hilar lymphadenopathy]] |
| | style="background: #F5F5F5; padding: 5px;" | | | # [[Pneumomediastinum]] |
| * Normal
| | # [[Sarcoidosis]] |
| | style="background: #F5F5F5; padding: 5px;" |
| | # [[Lymphoma]] |
| * Single
| | # [[Neurilemmoma]] |
| * Round, oval
| | # [[Non-Hodgkin lymphoma]] |
| * <5 mm nodule
| | # [[Teratoma]] |
| * Ground glass
| | # [[Thymoma]] |
| | style="background: #F5F5F5; padding: 5px;" |Fat in nodule
| | |
| | # [[Thyroid cancer]] |
| | # [[Goitre]] |
| | # [[Mediastinal germ cell tumor]], |
| | # [[Mediastinal tumor]], |
| | # [[Mediastinitis]] |
| | |
| | # [[Churg-Strauss syndrome]] |
| | # [[Bronchogenic cyst]], |
| | # [[Dermoid cyst]] |
| | # [[Anthrax]]: |
| | # [[Tularemia]] |
| | |
| | |
| | [[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]]] |
| | |
| | |
| | [[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])]] |
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| | |
| | __NOTOC__ |
| | {{SI}} |
| | {{CMG}}; {{AE}} {{Trusha}}, {{AM}} |
| | |
| | {{SK}} 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== |
|
| |
|
| Calcification
| |
| * Central dense nidus
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| * Diffuse solid
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| * Laminated
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| * Popcorn
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * well-defined smooth border
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| * Growth rate over 18 months
| |
| * Cavity wall thickness of 1 mm
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * N/A
| |
| | style="background: #F5F5F5; padding: 5px;" |N/A
| |
| | style="background: #F5F5F5; padding: 5px;" |↓ O2 Sat
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary Nodule (malignant)
| |
| | style="background: #F5F5F5; padding: 5px;" |++
| |
| | style="background: #F5F5F5; padding: 5px;" | ++
| |
| | style="background: #F5F5F5; padding: 5px;" | ++
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * [[Dyspnea]]
| |
| * Non resolving [[pneumonia]]
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| * [[Wheeze|Wheezing]]
| |
| * [[Chest pain]]
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| * [[Cachexia]]
| |
| * [[Fatigue]]
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| * [[Anorexia|Loss of appetite]]
| |
| * [[Dysphonia]]
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| * [[Dysphagia]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Hyporesonance
| |
| * Dull percussion
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
| |
|
| |
|
| * Present [[pleural friction rub]]
| |
| * Present [[egophony]]
| |
| * Crackling or bubbling noises
| |
| * Present whispered pectoriloquy
| |
| * Decreased/absent [[breath sounds]]
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Normal
| |
| | style="background: #F5F5F5; padding: 5px;" |'''Sputum cytology'''
| |
| * Tumor cells
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| * Multiple small
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| * Single > 2 cm of size
| |
| | style="background: #F5F5F5; padding: 5px;" |Calcification
| |
| * Amorphous
| |
| * Punctate
| |
| * Reticular
| |
| * Stippled or eccentric
| |
| Cavity
| |
|
| |
|
| Ulceration
| | ==Initial Evaluation== |
| *
| | {{familytree/start}} |
| | style="background: #F5F5F5; padding: 5px;" |
| | {{Family tree |border=2|boxstyle=background: WhiteSmoke;| | | | | A01 | | | | |A01=<div style="float: left; text-align: center; height: 1.25em; width: 25em; padding: 1em;">'''Mediastinal Mass'''</div>}} |
| * Spiculated border
| | {{familytree | | | | | |!| | | | | | | | }} |
| * Rapid growth rate (Doubling time 1-18 months)
| | {{familytree | | | | | B01 | | | |B01=<div style="float: left; text-align: left; line-height: 150%; padding: 1em; "> '''Workups''' |
| * Cavity wall thickness over 15 mm
| | ---- |
| | style="background: #F5F5F5; padding: 5px;" |
| | ❑ CT chest with contrast <br> ❑ Serum beta-HCG, AFP, if appropriate <br> ❑ CBC, platelets <br> ❑ PET-CT scan (optional) <br> ❑ Pulmonary function tests if clinically indicated <br> ❑ MRI chest if clinically indicated |
| * central necrosis
| | </div>}} |
| * Cavity lined by viable cancer cells without necrosis
| | {{familytree | |,|-|-|-|^|-|-|-|.| | | | | | | }} |
| *
| | {{familytree | C01 | | | | | | C02 | | | |C01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Likely''' </div> |C02= <div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em;"> '''Thymic Tumor Unlikely''' </div>}} |
| | style="background: #F5F5F5; padding: 5px;" |Biopsy and histopathological analysis
| | {{familytree | |!| | | | | | | |!| | | | | }} |
| |↓ O2 Sat
| | |
| |-
| | {{familytree | D01 | | | | | | D02 | | | |D01=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Consider [[Thymoma surgery|surgery]]</div>|D02=<div style="float: left; text-align: center; height: 1.25em; width: 15em; padding: 1em; text-size: 85%;">Disease-specific management</div>}} |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |
| | |
| | style="background: #F5F5F5; padding: 5px;" |
| | {{familytree/start}} |
| | style="background: #F5F5F5; padding: 5px;" | | | |
| | style="background: #F5F5F5; padding: 5px;" | | |
| | style="background: #F5F5F5; padding: 5px;" | | |
| *
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| | style="background: #F5F5F5; padding: 5px;" | | |
| | style="background: #F5F5F5; padding: 5px;" | | |
| *
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| | style="background: #F5F5F5; padding: 5px;" | | |
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| | style="background: #F5F5F5; padding: 5px;" | | |
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| !Diseases
| |
| ! colspan="1" rowspan="1" |Cough/Sputum
| |
| ! colspan="1" rowspan="1" |Cough/Sputum
| |
| !Weight loss
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| !Other symptoms
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| ! colspan="1" rowspan="1" |Percussion
| |
| !Auscultation
| |
| !CBC
| |
| !Sputum analysis
| |
| !Chest X-ray
| |
| !CT scan
| |
| !Other imaging
| |
| !Histopathology
| |
| |'''Gold standard'''
| |
| !Additional findings
| |
| |- | |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Abscess | |
| | style="background: #F5F5F5; padding: 5px;" | | |
| | style="background: #F5F5F5; padding: 5px;" | | |
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| | style="background: #F5F5F5; padding: 5px;" | | |
| | style="background: #F5F5F5; padding: 5px;" | | |
| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Septic emboli
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| | style="background: #F5F5F5; padding: 5px;" |
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| |- | |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Fungi | |
| | style="background: #F5F5F5; padding: 5px;" | | |
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| |- | |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Parasites | |
| | style="background: #F5F5F5; padding: 5px;" |
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Mycobacterial infections
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| | style="background: #F5F5F5; padding: 5px;" |
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| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Chronic inflammatory conditions
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| | style="background: #F5F5F5; padding: 5px;" |
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| !Diseases
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| ! colspan="1" rowspan="1" |Cough/Sputum
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| ! colspan="1" rowspan="1" |Cough/Sputum
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| !Weight loss
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| !Other symptoms
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| ! colspan="1" rowspan="1" |Percussion
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| !Auscultation
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| !CBC
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| !Sputum analysis
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| !Chest X-ray
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| !CT scan
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| !Other imaging
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| !Histopathology
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| |'''Gold standard'''
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| !Additional findings
| |
| |- | |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pulmonary AVMs | |
| | style="background: #F5F5F5; padding: 5px;" | | |
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| | style="background: #F5F5F5; padding: 5px;" | | |
| |-
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| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Pneumoconioses
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| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
| |
| | style="background: #F5F5F5; padding: 5px;" |
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| |}
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |