Sandbox:Trusha
IEditor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Trusha Tank, M.D.[3]
Overview
Differential diagnosis of mediastinal mass
Wide variety of medical conditions can present as a mediastinal mass on radiological imaging.
- Mediastinal mass may cause obstruction, entrapment or infiltration of other mediastinal organs such as: Trachea, bronchi, esophagus, aorta, superior vena cava (SVC) or heart.[1]
- Disorder caused by any kind of mediastinal mass is collectively known as: Mediastinal syndromes
- Mediastinal syndrome includes:
- Compression of the trachea: Dyspnea and respiratory insufficiency.
- Compression of the esophagus: Dysphagia.
- Compression of SVC causes superior vena cava syndrome: Vein distention, edema of the face or upper extremities and a positive Pemberton's sign.
- Pemberton's sign: Development of suffusion, plethora, or duskiness upon elevation of the arms above the head in patient
- Superior vena cava syndrome is the most severe complication of mediastinal syndrome and a medical emergency.
ABBREVIATIONS: N/A: Not available, SOB: Shortness of breath, M/C: Most common, RI: Respiratory insufficiency, NM: Neuromuscular system, SVCS: Superior vena cava syndrome, SLE: Systemic lupus erythematosus disease, T3: Triiodothyronine, T4: Thyroxine, TSH: Thyroid stimulating hormone, TFT: Thyroid function test | |||||||||
Class | Disease | Etiology | Clinical presentation | Paraclinical findings | |||||
---|---|---|---|---|---|---|---|---|---|
General symptoms | Mediastinal syndrome | ||||||||
Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | ||||
Anterior mediastinal mass | |||||||||
Tumors | Thymoma |
|
+ | + | + | Biopsy:
|
Associated condition
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | |
Fatty mass |
|
|
- | - | - | MRI:
|
Fatty mass can be:
| ||
Non-Hodgkin lymphoma |
(HIV, Hep C, HTLV-1, EBV, HHV-8, H. pylori, psittacosis, Campylobacter jejuni)
(pesticides, methotrexate, TNF inhibitors, trichloroethylene)
|
|
+/- | +/- | +/- | Excisional lymph node biopsy with immunohistochemical study
|
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | |
Teratoma |
|
Benign
Malignant |
+/- | +/- | +/- | Chest CT scan:
|
N/A | ||
Thyroid disease | Thyroid cancer |
|
|
+ | + | - | US guided biopsy: | TFT | |
Goiter |
|
+ | + | - | Radioactive iodine scan:
|
Hyperavtive gland (hyperthyroid):
Hypoactive gland (hypothyroid):
Normal functioning gland (euthyroid):
| |||
Class | Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Middle mediastinal mass | |||||||||
CVS disease | Pericardial effusion |
|
|
+ | +/- | - | Echocardiography guided pericardiocentesis:
|
Physical findings:
EKG: Echo:
| |
Aortic dissection |
|
+ | +/- | + | MRI: | TEE:
CTA:
| |||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | |
Superior vena cava obstruction | Compression of SVC from: |
|
+ | + | ++ | Contrast-enhanced CT scan:
|
Invasive contrast venography:
| ||
Partial anomalous pulmonary venous connection |
|
|
+ | - | - | MRI with contrast:
|
Associated with
PFT:
| ||
GI disease | Esophageal achalasia |
|
+ | + | - | High resolution manometry (HRM):
|
X ray:
| ||
Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings | |
Esophageal cancer |
|
|
- | + | - | Endoscopy with biopsy:
|
Barium swallow:
| ||
Esophageal rupture |
|
Other: Patients with cervical perforations can present with
|
+ | + | - | Esophagogram:
|
CT scan:
| ||
Hiatus hernia |
|
- | + | - | High resolution manometry with esophageal pressure topography (EPT):
|
Ultrasound:
Ultrasound in pediatric population:
| |||
Class | Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Pulmonary disease | Hilar lymphadenopathy | Lymphadenopathy:
|
Constituitional symptoms like:
|
+ | - | - | Lymph node biopsy and histopathology | CT scan | |
Pneumomediastinum |
|
|
CT scan:
Pediatric pneumomediastinum: |
Physical exam:
| |||||
Sarcoidosis |
Genetic factors Sarcoidosis is the result of environmental triggers acting upon an immunogenetically susceptible host. The importance of genetic factors in pathophysiology of sarcoidosis is supported by familial clusters of sarcoidosis.
Immune System Sarcoidosis is the result of environmental triggers acting upon an immunogenetically susceptible host.
Drug side effect
|
||||||||
Mediastinal tumor | Mediastinal tumor | ||||||||
Mediastinal germ cell tumor | |||||||||
Infection | Mediastinitis | ||||||||
Anthrax | |||||||||
Tularemia | |||||||||
Cystic disease | Dermoid cyst | ||||||||
Bronchogenic cyst | |||||||||
Chronic
inflammatory |
Churg-Strauss syndrome | ||||||||
Class | Disease | Etiology | Symptoms | Dyspnea/
RI |
Dysphagia | SVCS | Gold standard | Image | Additional findings |
Posterior mediastinal mass | |||||||||
CNS disease | Meningocele[2] | ||||||||
Neurilemmoma[2] | |||||||||
ABBREVIATIONS: N/A: Not available, SOB: Shortness of breath, M/C: Most common, RI: Respiratory insufficiency, NM: Neuromuscular system, SVCS: Superior vena cava syndrome, SLE: Systemic lupus erythematosus disease, T3: Triiodothyronine, T4: Thyroxine, TSH: Thyroid stimulating hormone, TFT: Thyroid function test |
- Superior vena cava obstruction
- Partial anomalous pulmonary venous connection
- Esophageal achalasia
- Esophageal cancer
- Esophageal rupture
- Hiatus hernia
- Hilar lymphadenopathy
- Pneumomediastinum
- Sarcoidosis
- Lymphoma
- Neurilemmoma
- Non-Hodgkin lymphoma
- Teratoma
- Thymoma
References
- ↑ Zardi EM, Pipita ME, Afeltra A (October 2016). "Mediastinal syndrome: A report of three cases". Exp Ther Med. 12 (4): 2237–2240. doi:10.3892/etm.2016.3596. PMC 5038184. PMID 27698718.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L (February 2013). "A diagnostic approach to the mediastinal masses". Insights Imaging. 4 (1): 29–52. doi:10.1007/s13244-012-0201-0. PMID 23225215.
- ↑ 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.
- ↑ Sandlund JT (2015). "Non-Hodgkin Lymphoma in Children". Curr Hematol Malig Rep. 10 (3): 237–43. doi:10.1007/s11899-015-0277-y. PMID 26174528.
- ↑ Armitage JO, Gascoyne RD, Lunning MA, Cavalli F (2017). "Non-Hodgkin lymphoma". Lancet. 390 (10091): 298–310. doi:10.1016/S0140-6736(16)32407-2. PMID 28153383.
- ↑ Yalagachin GH (June 2013). "Anterior mediastinal teratoma- a case report with review of literature". Indian J Surg. 75 (Suppl 1): 182–4. doi:10.1007/s12262-012-0569-6. PMID 24426558.
- ↑ 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.
- ↑ "Benign thyroid enlargement (non-toxic multinodular goiter): Overview".
- ↑ 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.
- ↑ 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.
- ↑ Weissmann-Brenner A, Schoen R, Divon MY (2004). "Aortic dissection in pregnancy". Obstet Gynecol. 103 (5 Pt 2): 1110–3. doi:10.1097/01.AOG.0000124984.82336.43. PMID 15121626.
- ↑ Brooke V, Goswami S, Mohanty A, Kasi PM (2012). "Aortic dissection and renal failure in a patient with severe hypothyroidism". Case Rep Med. 2012: 842562. doi:10.1155/2012/842562. PMC 3399550. PMID 22829842.
- ↑ "Classification of diabetic retinopathy from fluorescein angiograms. ETDRS report number 11. Early Treatment Diabetic Retinopathy Study Research Group". Ophthalmology. 98 (5 Suppl): 807–22. 1991. PMID 2062514.
- ↑ Uberoi R (2006). "Quality assurance guidelines for superior vena cava stenting in malignant disease". Cardiovasc Intervent Radiol. 29 (3): 319–22. doi:10.1007/s00270-005-0284-9. PMID 16502166.
- ↑ Cohen R, Mena D, Carbajal-Mendoza R, Matos N, Karki N (2008). "Superior vena cava syndrome: A medical emergency?". Int. J. Angiol. 17 (1): 43–6. PMID 22477372.
- ↑ 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.
- ↑ Broy C, Bennett S (June 2008). "Partial anomalous pulmonary venous return". Mil Med. 173 (6): 523–4. PMID 18595412.
- ↑ Gockel I, Müller M, Schumacher J (2012). "Achalasia--a disease of unknown cause that is often diagnosed too late". Dtsch Arztebl Int. 109 (12): 209–14. doi:10.3238/arztebl.2012.0209. PMC 3329145. PMID 22532812.
- ↑ Ghoshal UC, Daschakraborty SB, Singh R (2012). "Pathogenesis of achalasia cardia". World J. Gastroenterol. 18 (24): 3050–7. doi:10.3748/wjg.v18.i24.3050. PMC 3386318. PMID 22791940.
- ↑ Ates F, Vaezi MF (2015). "The Pathogenesis and Management of Achalasia: Current Status and Future Directions". Gut Liver. 9 (4): 449–63. doi:10.5009/gnl14446. PMC 4477988. PMID 26087861.
- ↑ Boeckxstaens GE, Zaninotto G, Richter JE (2013). "Achalasia". Lancet. doi:10.1016/S0140-6736(13)60651-0. PMID 23871090.
- ↑ Corley DA, Kerlikowske K, Verma R, Buffler P. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003;124:47-56. PMID 12512029. See also NCI - "Esophageal Cancer (PDQ®): Prevention".
- ↑ Wong A, Fitzgerald RC. Epidemiologic risk factors for Barrett's esophagus and associated adenocarcinoma. Clin Gastroenterol Hepatol. 2005 Jan;3(1):1-10. PMID 15645398
- ↑ Ye W, Held M, Lagergren J, Engstrand L, Blot WJ, McLaughlin JK, Nyren O. Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia. J Natl Cancer Inst. 2004 Mar 3;96(5):388-96. PMID 14996860
- ↑ Nakajima S, Hattori T. Oesophageal adenocarcinoma or gastric cancer with or without eradication of Helicobacter pylori infection in chronic atrophic gastritis patients: a hypothetical opinion from a systematic review. Aliment Pharmacol Ther. 2004 Jul;20 Suppl 1:54-61. PMID 15298606
- ↑ NCI Prevention: Dietary Factors, based on Chainani-Wu N. Diet and oral, pharyngeal, and esophageal cancer. Nutr Cancer 2002;44:104-26. PMID 12734057.
- ↑ McGovern M, Egerton MJ (1991). "Spontaneous perforation of the cervical oesophagus". Med. J. Aust. 154 (4): 277–8. PMID 1994204.
- ↑ Wilson RF, Sarver EJ, Arbulu A, Sukhnandan R (1971). "Spontaneous perforation of the esophagus". Ann. Thorac. Surg. 12 (3): 291–6. PMID 5112482.
- ↑ Bladergroen MR, Lowe JE, Postlethwait RW (1986). "Diagnosis and recommended management of esophageal perforation and rupture". Ann. Thorac. Surg. 42 (3): 235–9. PMID 3753071.
- ↑ Dodds WJ, Stewart ET, Vlymen WJ (1982). "Appropriate contrast media for evaluation of esophageal disruption". Radiology. 144 (2): 439–41. doi:10.1148/radiology.144.2.7089304. PMID 7089304.
- ↑ James AE, Montali RJ, Chaffee V, Strecker EP, Vessal K (1975). "Barium or gastrografin: which contrast media for diagnosis of esophageal tears?". Gastroenterology. 68 (5 Pt 1): 1103–13. PMID 1126592.
- ↑ Schwartz SS (1975). "Letter: Barium or gastrografin: which contrast media for diagnosis of esophageal tears?". Gastroenterology. 69 (6): 1377. PMID 1193339.
- ↑ Vessal K, Montali RJ, Larson SM, Chaffee V, James AE (1975). "Evaluation of barium and gastrografin as contrast media for the diagnosis of esophageal ruptures or perforations". Am J Roentgenol Radium Ther Nucl Med. 123 (2): 307–19. PMID 1115308.
- ↑ Khajanchee YS, Cassera MA, Swanström LL, Dunst CM (January 2013). "Diagnosis of Type-I hiatal hernia: a comparison of high-resolution manometry and endoscopy". Dis. Esophagus. 26 (1): 1–6. doi:10.1111/j.1442-2050.2011.01314.x. PMID 22320417.
- ↑ Chang P, Friedenberg F (2014). "Obesity and GERD". Gastroenterol Clin North Am. 43 (1): 161–73. doi:10.1016/j.gtc.2013.11.009. PMC 3920303. PMID 24503366.
- ↑ Jash, Debraj; Maji, Arnab; Patra, Anupam; Sarkar, Supriya (2013). "Approach to unequal hilum on chest X-ray". The Journal of Association of Chest Physicians. 1 (2): 32. doi:10.4103/2320-8775.123204. ISSN 2320-8775.
- ↑ Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
- ↑ Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A (2014). "Peripheral lymphadenopathy: approach and diagnostic tools". Iran J Med Sci. 39 (2 Suppl): 158–70. PMC 3993046. PMID 24753638.
- ↑ Lymph node enlargment. Radiopedia. http://radiopaedia.org/articles/lymph-node-enlargement Accessed on May 9, 2016
- ↑ Utsumi T, Shiono H, Fukai I, Akashi A (2007). "Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum". Interactive cardiovascular and thoracic surgery. 6 (3): 411–2. doi:10.1510/icvts.2006.147355. PMID 17669882.
- ↑ name="pmid18721592">Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE (September 2008). "Spontaneous pneumomediastinum: a comparative study and review of the literature". Ann. Thorac. Surg. 86 (3): 962–6. doi:10.1016/j.athoracsur.2008.04.067. PMID 18721592.
- ↑ Kim, Hye Rin; Yoo, Seung Min; Lee, Hwa Yeon; Han, Jin Hee; Frazier, Aletta A; White, Charles S (2016). "Presence of subpleural pulmonary interstitial emphysema as an indication of single or multiple alveolar ruptures on CT in patients with spontaneous pneumomediastinum". Acta Radiologica. 57 (12): 1483–1489. doi:10.1177/0284185116629830. ISSN 0284-1851.
- ↑ . doi:10.3978/j.issn.2072-1439.2015.01.11. Missing or empty
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(help) - ↑ Chiu CY, Wong KS, Yao TC, Huang JL (March 2005). "Asthmatic versus non-asthmatic spontaneous pneumomediastinum in children". Asian Pac. J. Allergy Immunol. 23 (1): 19–22. PMID 15997870.
- ↑ Iyer VN, Joshi AY, Ryu JH (May 2009). "Spontaneous pneumomediastinum: analysis of 62 consecutive adult patients". Mayo Clin. Proc. 84 (5): 417–21. doi:10.1016/S0025-6196(11)60560-0. PMC 2676124. PMID 19411438.
- ↑ Dionísio, Patrícia; Martins, Luís; Moreira, Susana; Manique, Alda; Macedo, Rita; Caeiro, Fátima; Boal, Luísa; Bárbara, Cristina (2017). "Spontaneous pneumomediastinum: experience in 18 patients during the last 12 years". Jornal Brasileiro de Pneumologia. 43 (2): 101–105. doi:10.1590/s1806-37562016000000052. ISSN 1806-3756.