Mediastinal lesions are caused by a variety of cysts and tumors. The probable cause is different depending on the age of the patient and the location of the mass (front, middle or rear mediastinum). The lesion may be asymptomatic (in adults) or obstructive respiratory symptoms lead (in children). The diagnosis consists of a CT biopsy and possibly further investigations. The treatment varies depending on the cause.
Mediastinal lesions are caused by a variety of cysts and tumors. The probable cause is different depending on the age of the patient and the location of the mass (front, middle or rear mediastinum). The lesion may be asymptomatic (in adults) or obstructive respiratory symptoms lead (in children). The diagnosis consists of a CT biopsy and possibly further investigations. The treatment varies depending on the cause. Etiology Mediastinal masses are classified in the front, middle and rear mediastinum. The front mediastinum extends from the sternum to the pericardium and the rear brachiocephalic blood vessels. The middle mediastinum is located between the front and rear portion. The posterior mediastinum is limited to the front of the pericardium and the trachea and rearwardly through the spine. Adults In adults vary the most common causes depending on location: Front mediastinum: Thymomas and lymphomas (both Hodgkin and non-Hodgkin) Middle mediastinum: lymph node swelling and vascular space Forderunge Rear mediastinum: neurogenic tumors and malformations of the esophagus Other causes can be found in some causes of mediastinal lesions in adults. Some causes of mediastinal masses in adults. Children The most common mediastinal masses in children are neurogenic tumors and cysts. Other causes can be found in See Table: Some causes of mediastinal masses in children. Some causes of mediastinal masses in children able cause anterior ectopic thyroid lymphoma sarcoma teratoma means Bronchogenic cyst heart cancer Cystic hygroma lymphadenopathy lymphoma pericardial cyst Vascular anomalies Posterior esophageal duplication Meningomyelocel hematologic changes Neurogenic tumors Symptoms and complaints Many mediastinal masses are asymptomatic. In general, malignant lesions and lesions cause a lot more symptoms in children. The most common symptoms are chest pain and weight loss. Lymphomas can manifest with fever and weight loss. In children mediastinal masses frequently cause tracheobronchial compression and stridor or symptoms of recurrent bronchitis or pneumonia. The symptoms and complaints are also dependent on the location. Large lesions in the anterior mediastinum can cause dyspnea when patients lie on their backs. Lesions in the middle mediastinum can compress blood vessels or airways and lead to superior vena cava syndrome or airway obstruction. Lesions in the posterior mediastinum can spread to the esophagus and cause dysphagia or odynophagia. Diagnostic chest X-ray CT Sometimes tissue examination Most mediastinal lesions are discovered as incidental findings on a chest x-ray image or other imaging techniques that have been made because of a thoracic symptoms. Further investigations, incl. Imaging and biopsy are indicated for etiological investigation. The contrast-enhanced CT scan is the most important imaging methods. With a chest CT normal variants and benign tumors such as fat and fluid-filled cysts can be distinguished from other causes. A definitive diagnosis can be obtained in many mediastinal lesions by fine needle aspiration or core biopsy. Fine needle aspiration is usually sufficient in carcinoma; However, if lymphoma, thymoma or neurogenic tumors are suspected, a biopsy should be done. For the diagnosis of ectopic thyroid TSH levels is determined. Treatment Depending on the cause, the treatment depends on the etiology. Some benign diseases such as pericardial cysts need only be observed. Most malignant tumors should be removed surgically, but some, such as lymphomas, are best treated with chemotherapy (n. D. Talk .: depending on the extension). Granulomatous disease should be treated with appropriate antimicrobial drugs. Summary In adults, thymomas and lymphomas (both Hodgkin and non-Hodgkin) the most common anterior lesions, lymph node swelling and vascular lesions are the most common central lesions and neurogenic tumors and malformations of the esophagus are the most common posterior lesions. The most common mediastinal masses in children are neurogenic tumors and cysts. The most common symptoms are chest pain and weight loss, but many lesions are asymptomatic. Obstructive pulmonary disease can occur in children. The contrast-enhanced CT scan is the most important imaging methods.