Thoracic Neoplasms Flashcards
Mediastinum
Anatomic space located between the lungs
Anterior mediastinum borders
Sternum to anterior aspect of the heart
Anterior mediastinum contents
Thymus
Internal mammary arteries
Lymph nodes
MC etiologies of anterior mediastinal masses
Thymoma
Teratoma
Thyroid/parathyroid
Middle mediastinal borders
Anterior aspect of the heart to the posterior aspect of the heart
Contents of middle mediastinum
Heart
Great vessels
Trachea
MC etiologies of middle mediastinal masses
Granulomatous or metastatic lymphadenopathy
Posterior mediastinum borders
Everything posterior to the heart
Contents of posterior mediastinum
Esophagus
Thoracic duct
Sympathetic chain
Spine
Descending thoracic aorta
MC etiologies of posterior mediastinal masses
Neurogenic tumors
Meningocele
Esophageal diverticula
Hiatal hernia
50% of mediastinal masses are found ___
Incidentally
Clinical presentation of mediastinal mass
Symptoms related to the structures that are compressed by the mass
Constitutional symptoms if malignant
Effects of compression of the lungs, esophagus, vascular, heart and sympathetic chain
Lungs: hoarseness
Esophagus: dysphagia
Vascular: facial or extremity swelling
Heart: hypotension
Sympathetic chain: Horner’s syndrome
Initial imaging of a mediastinal mass
CXR
If the CXR is inconclusive, what is the follow-up imaging for mediastinal mass?
Chest CT with IV contrast
If the patient complains of difficulty swallowing due to mediastinal mass, what test could be run?
Barium swallow
If there is a suspected malignancy of mediastinal mass, what test should be run first?
PET scan
PET scan
Shows metabolic activity
Anti-acetylcholine receptor antibodies are elevated in ___ tumors
Thymic
Alpha fetoprotein and beta HCG are elevated in ___ tumors
Germ cell
LDH is elevated in ___ tumors
Seminomas and lymphoma
Referral for mediastinal masses
Cardiothoracic or general surgery
Indications for percutaneous biopsy of mediastinal mass
If it is near the periphery of the chest
Percutaneous biopsy
Uses CT guidance for exact location of biopsy