Mediastinal Masses Flashcards

1
Q

What are the boundaries of the mediastinum?

A
Superiorly -> thoracic inlet 
Inferiorly -> diaphragm 
Anteriorly -> sternum 
Posteriorly -> spine 
Laterally -> pleural spaces
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2
Q

What does the anterior compartment of the mediastinum contain?

A
  • thymus
  • internal mammary vessels
  • lower pole of thyroid
  • ectopic thyroid
  • lymph nodes
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3
Q

What are the components of the posterior compartment of the mediastinum (paraventral sulcus)?

A
  • sympathetic chain
  • proximal portion of intercostal neurovascular bundles
  • thoracic spinal ganglia
  • azygous vein & lymph nodes & fat
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4
Q

What are the components of the middle compartment (visceral) of the mediastinum?

A
  • great vessels
  • heart
  • pericardium
  • trachea
  • proximal main stem bronchi
  • vagus nerves
  • phrenic nerves
  • esophagus
  • thoracic duct
  • descending aorta
  • azygous venous system
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5
Q

What are the tumors of the mediastinum?

A

4Ts

  • thymic -> thymoma - thymic cyst
  • lymphoma -> terrible lymphoma - Hodgkin & non Hodgkin)
  • germ cell -> teratoma
  • thyroid -> goiter - carcinoma
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6
Q

What are the common tumors in the visceral (middle) compartment?

A
  • forgut cysts -> bronchogenic - esophageal - gastric
  • tracheal & esophageal tumors
  • primary or secondary tumors of lymph nodes
  • lymphoma
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7
Q

What are the common tumors occurring in the paravertebral sulci (posterior)?

A
  • neurogenic -> neurofibroma - shwannoma
  • vascular
  • mesenchymal
  • lymphatic
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8
Q

What are the tumors occurring in the anterior compartment?

A
  • thymoma
  • lymphoma
  • seminoma (alpha fetoprotein)
  • carcinoma
  • cystic masses: thymic cyst - pericardial cyst
  • bronchogenic cyst
  • teratoma
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9
Q

What are the most common tumors of the mediastinum in children?

A

1- neurogenic
2- lymphomas
3- foregut cysts
4- benign germ cell tumors

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10
Q

What is the most common mediastinum tumor in adults?

A

Thymic tumors

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11
Q

What are the most common presenting complaints in a mediastinal mass?

A
  • chest pain
  • cough
  • dyspnea
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12
Q

What are the signs of anatomic invasion or compression of a mediastinal mass?

A
  • 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
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13
Q

How should diagnosis of mediastinal mass occur?

A
CT or MRI
then 
Tissue diagnosis 
If big mass -> fine needle 
If small non-invasive -> surgical excision & biopsy
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14
Q

What are the signs seen on X ray suggesting a mass?

A
  • anterior mediastinum: aorta pulmonary window fullness
  • middle mediastinum: tracheal displacement
  • posterior mediastinum: supraclavicular mass
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