General Surgery – Mediastinal Mass: By Rishindra M. Reddy M.D.


The mediastinum is an anatomical cavity, which
is in between the lungs, and includes the heart, aorta, thymus, trachea and esophagus. Its boundaries are formed by the sternum anteriorly,
the spine posteriorly and the lungs laterally. Further, the mediastinum can be subdivided
into three anatomical areas, specifically the anterior, middle, and posterior mediastinum. These distinctions are important, as the location
of a mass can hint to its etiology. Masses in the anterior mediastinum can include: Lymphoma (Hodgkin’s and non-Hodgkin’s)
Thymoma and thymic cysts Germ cell tumours
Retrosternal goiters (Thyroid masses) Masses in the middle mediastinum can include: Lymphadenopathy (enlarged lymph nodes)
Tracheal tumours Bronchogenic cysts/tumors
Pericardial cysts Masses in the posterior mediastinum can include: Esophageal tumors
Esophageal diverticula Paraesophageal hiatal hernias
Lymphadenopathy Nerve sheath tumours Diagnosis of mediastinal masses is difficult,
because many patients will be asymptomatic until the mass begins to encroach on surrounding
structures. As such, large anterior masses may cause dyspnea
when the patient lies supine. Similarly, posterior masses may cause dysphagia
or odynophagia by compressing the esophagus. Lymphomas will typically present with “B”
symptoms, and may be diagnosed earlier if the following are present: Night time sweating
Fever of>38C Unexplained weight loss Most commonly however, a mediastinal mass
will be discovered incidentally on chest x-ray. Further investigation may involve a CT/MRI
scan, followed by a tissue biopsy, if indicated, which can be performed by endoscopy, thorocoscopy,
external needle biopsy, etc. Treatment typically depends on the type of
tumour. Thymic cancers may be treated by surgical
resection and possibly radiation. Lymphomas are treated with chemotherapy followed
by radiation.

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