Mediastinal Masses

Question 1

What is the definition of a Pancoast tumor?

Answer 1

A Pancoast tumor compresses the mediastinum, which is bound by the thoracic inlet, diaphragm, sternum, vertebral bodies, and pleura

It can affect the cervical sympathetic plexus.

Question 2

What are the three compartments of the mediastinum?

Answer 2

Anterior, middle, and posterior

These compartments help classify mediastinal masses.

Question 3

What are the clinical features of mediastinal masses?

Answer 3

50% asymptomatic; when symptomatic, 50% are malignant. Symptoms include:
* Chest pain
* Cough
* Dyspnea
* Recurrent respiratory infections
* Hoarseness
* Dysphagia
* Horner’s syndrome
* Facial/upper extremity edema (SVC compression)

Asymptomatic cases are often benign.

Question 4

What is Horner’s syndrome characterized by?

Answer 4

Miosis, anhidrosis, and ptosis

It is a sign of sympathetic nervous system involvement.

Question 5

What are the ‘Four Ts’ associated with anterior compartment masses?

Answer 5

Thymoma, teratoma, thyroid enlargement (goitre), and terrible lymphoma

These are common types of tumors found in the anterior mediastinum.

Question 6

What are common masses found in the middle compartment?

Answer 6

Pericardial cyst, bronchogenic cyst/tumor, lymphoma, lymph node enlargement, and aortic aneurysm
Lung cancer
Abscess
Bilateral hilar lymphadenopathy

These can lead to various clinical presentations.

Question 7

What is included in the posterior compartment of the mediastinum?

Answer 7

Esophagus, vagus nerve, thoracic duct, sympathetic chain, and azygous venous system

These structures are important for understanding posterior mediastinal masses.

Question 8

What imaging investigations are commonly used for mediastinal masses?

Answer 8

1. CXR.
2. CT with contrast.
3. MRI: specifcally indicated in the evaluation of neurogenic tumours.
4. U/S: best for assessment of structures in close proximity to the heart and pericardium
5. radionuclide scanning, and biochemical studies

Each has specific indications based on the suspected pathology.

Question 9

What is the management for symptomatic benign masses that are enlarging?

Answer 9

Excision

This is also the approach for masses with concerns for malignancy.

Question 10

When should a diagnostic biopsy be preferred over major operation?

Answer 10

If the mass is likely to be a lymphoma, germ cell tumor, or unresectable invasive malignancy

This approach minimizes unnecessary surgical risk.

Question 11

What should be noted if AFP, ß-hCG, or LDH levels are elevated?

Answer 11

No biopsy should be performed as these are pathognomonic for germ cell tumors

Elevated levels indicate a high likelihood of germ cell tumor presence.

Question 12

True or False: 50% of mediastinal masses are asymptomatic.

Answer 12

True

Many benign masses do not produce symptoms.

Question 13

What is Horner’s syndrome?

Answer 13

A condition characterized by ptosis, miosis, and anhidrosis due to disruption of the sympathetic nerves supplying the eye.

Question 14

True or False: A Pancoast tumour can compress the cervical sympathetic plexus.

Answer 14

True

Question 15

Fill in the blank: A Pancoast tumour primarily affects the _____ of the lung.

Answer 15

apex

Question 16

What are the classic symptoms of Horner’s syndrome?

Answer 16

Ptosis, miosis, and anhidrosis.

Question 17

Multiple Choice: Which structure is primarily affected by a Pancoast tumour leading to Horner’s syndrome?
A) Trachea
B) Cervical sympathetic plexus
C) Phrenic nerve
D) Vagus nerve

Answer 17

B) Cervical sympathetic plexus

Question 18

What are the common masses found in the posterior mediastinum ?

Answer 18

1. Neurogenic tumors (most common) : Neuroendocrine tumors and Neurofibromas.
2. Esophageal cancer
3. Multiple myeloma [3]
4. Lymphoma
5. Lung cancer
6. Abscess
7. Aneurysm

Question 19

Whats the most common cause of mediastinitis ?

Answer 19

• include spreading of retropharyngeal infections into the mediastinum, chest trauma, and perforation of mediastinal organs, e.g., the esophagus in the course of a gastroscopy or due to esophageal cancer.

Question 20

Answer 20

In the posterior mediastinum => a large mass (most commonly due to neurogenic tumor, need a biopsy to confirm)

Axial CT scan with IV contrast

Question 21

Whats the primary muscle for inspiration ?

Answer 21

Diaphragm

Question 22

Answer 22

Pectus Excavatum → Funnel chest, 90%, 5 to 1 male predominance.

Question 23

Answer 23

Pectus Carinatum → Pigeon chest, second most common, 4 to 1 male
predominance

Question 24

Answer 24

Poland syndrome Absent Pectoralis muscle, more common right
side.

Question 25

Poland syndrome is associated with what conditions?

Answer 25

associated with/ Leiosarcoma, NHL,
KF Syndrome, Leukemia, Renal anomalies.