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Mediastinum (Hong Kong, China) 2023Mediastinal lesions are uncommon. However, because of the vital structures in the mediastinum, large lesions specifically can lead to life-threatening situations.... (Review)
Review
BACKGROUND AND OBJECTIVE
Mediastinal lesions are uncommon. However, because of the vital structures in the mediastinum, large lesions specifically can lead to life-threatening situations. Treatment and management vary considerably with the disease. Therefore, the correct histopathologic diagnosis is important. Here we review lesions that have the potential to present as a giant lesion in the mediastinum. While we focus on the review of histopathologic, immunohistochemical (IHC), and molecular features of these lesions, clinical symptoms and characteristics and prognosis will also be discussed.
METHODS
"Giant" was arbitrarily defined as a size of at least 10 cm in greatest dimension. The 2021 World Health Organization (WHO) classification of mediastinal tumors was searched for tumors reported to be larger than 10 cm. Tumors that can present as giant mediastinal lesions based on our own experience were also included. PubMed search was then performed for these lesions.
KEY CONTENT AND FINDINGS
A great variety of mediastinal lesions can present as giant mass. Those include for instance tumors of blood and lymph vessels, tumors of neurogenic origin, mesenchymal neoplasms, thymic epithelial tumors (TETs), and non-neoplastic cysts. Lesions range from benign to malignant. This review focuses on the most common lesions.
CONCLUSIONS
Many benign and malignant lesions can become a large mass in the mediastinum. Their correct diagnosis is important for the treatment and management of the patient.
PubMed: 38090032
DOI: 10.21037/med-23-23 -
Archives of Disease in Childhood.... Dec 2021A 12-month-old infant was referred with a 6-week history of recurrent admissions with worsening stridor. On each previous admission, the stridor responded well, but...
A 12-month-old infant was referred with a 6-week history of recurrent admissions with worsening stridor. On each previous admission, the stridor responded well, but transiently, to oral dexamethasone. At this presentation, he required high-dependency unit care with high flow oxygen due to marked increased work of breathing.He was born at term, previously well, and up to date with immunisations. There was no significant family history. There were no smokers and two cats at home.He was afebrile with moderate subcostal recession and tracheal tug. On auscultation, breath sounds were normal with transmitted sounds of inspiratory and expiratory stridor. The rest of his examination was normal.He commenced dexamethasone 0.15 μg/kg three times a day, which was weaned as his clinical status improved.Blood tests showed total white cell count 9 x 10ˆ9/L, CRP <1 mg/L, lactate dehydrogenase level and blood film normal. Chest radiograph showed left lung hyperexpansion and apparent right-sided bronchial narrowing (figure 1). Flexible nasendoscopy was unremarkable. Microlaryngoscopy and bronchoscopy showed external airway compression at the level of the carina (figure 2). CT thorax demonstrated a non-enhancing mediastinal mass extrinsic to the airway, approximately 3cmx2.5cmx1.5cm, compressing the carina and main-stem bronchi (figure 3).
Topics: Animals; Bronchoscopy; Cats; Humans; Male; Mediastinum; Radiography; Respiratory Sounds; Tomography, X-Ray Computed
PubMed: 32132092
DOI: 10.1136/archdischild-2019-318092 -
Journal of Nuclear Cardiology :... Dec 2023
Topics: Humans; Cardiovascular System; Molecular Imaging; Heart; Mediastinum
PubMed: 33655449
DOI: 10.1007/s12350-021-02534-9 -
The Thoracic and Cardiovascular Surgeon Dec 2022The aim of this study was to investigate the application value of transcatheter arterial embolization (TAE) for mediastinal hemorrhage.
PURPOSE
The aim of this study was to investigate the application value of transcatheter arterial embolization (TAE) for mediastinal hemorrhage.
MATERIALS AND METHODS
The study retrospectively analyzed the status of TAE treatment in 13 patients with mediastinal hemorrhage.
RESULTS
Aortic angiography and bleeding artery angiography showed that the bleeding in 13 mediastinal hemorrhage patients, respectively, originated from intercostal artery, esophageal artery, or bronchial artery. All patients were embolized with gelatin sponge and (or) polyvinyl alcohol particles. Chest computed tomography scan found that all 13 patients showed reduced range of mediastinal hematoma after TAE.
CONCLUSION
TAE has the advantages of reduced trauma, rapid and direct hemostasis, and solid therapeutic effects in the treatment of mediastinal hemorrhage.
Topics: Humans; Retrospective Studies; Treatment Outcome; Hemorrhage; Embolization, Therapeutic; Angiography
PubMed: 34972238
DOI: 10.1055/s-0041-1735827 -
The Annals of Thoracic Surgery Jan 2021Cardiac tamponade results from compression of the heart and great vessels. Mediastinal hematoma has been reported in association with cardiac tamponade in multiple...
Cardiac tamponade results from compression of the heart and great vessels. Mediastinal hematoma has been reported in association with cardiac tamponade in multiple settings, including nonaortic mediastinal hemorrhage from cervical spine fractures, aortic and carotid aneurysmal rupture, mediastinal penetrating trauma, and cardiac penetrating trauma. A few cases of blunt trauma to the anterior chest wall resulting in tamponade formation have been reported. We present a patient with an anterior mediastinal hematoma resulting from blunt chest trauma that caused extrapericardial cardiac tamponade due to bleeding from a branch of the left internal mammary artery after a motor vehicle collision.
Topics: Adult; Cardiac Tamponade; Hematoma; Humans; Male; Mediastinal Diseases; Pericardium; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 32531210
DOI: 10.1016/j.athoracsur.2020.04.098 -
Postgraduate Medical Journal Jan 2020
Topics: Asymptomatic Diseases; Diagnosis, Differential; Female; Hematopoiesis, Extramedullary; Hepatomegaly; Humans; Incidental Findings; Mediastinum; Middle Aged; Radiography, Thoracic; Splenomegaly; Tomography, X-Ray Computed; beta-Thalassemia
PubMed: 31511317
DOI: 10.1136/postgradmedj-2019-137039 -
Journal of Cardiothoracic Surgery Mar 2022Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and...
BACKGROUND
Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.
METHODS
Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.
RESULTS
The average age of patients was 5.3 ± 2.9 (1.3-13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0-100.0%), 25 (49.0%, CI 34.8-63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8-70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6-20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4-88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.
CONCLUSION
TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.
Topics: Adolescent; Asphyxia; Child; Child, Preschool; Female; Hemorrhage; Humans; Infant; Male; Prognosis; Retrospective Studies; Spinal Cord Injuries
PubMed: 35282839
DOI: 10.1186/s13019-022-01773-2 -
Kyobu Geka. the Japanese Journal of... Sep 2021The mediastinum contains large blood vessels, airways, and spinal cord, which are anatomically important parts of the human body because they survive by injury,...
The mediastinum contains large blood vessels, airways, and spinal cord, which are anatomically important parts of the human body because they survive by injury, obstruction, and compression, and are involved in activities of daily living( ADL). Therefore, even benign tumors have been indicated for aggressive surgical intervention. Dissection procedures from these anatomically important structures is extremely risky and difficult in reoperation for recurrence of mediastinal tumors, so careful consideration and attention must be paid to the surgical indications and methods. In this paper, we have described the points to be noted and points regarding the reoperation of mediastinal tumors with some review of the literature, including our own cases.
Topics: Activities of Daily Living; Humans; Mediastinal Neoplasms; Mediastinum; Neoplasm Recurrence, Local; Reoperation
PubMed: 34548456
DOI: No ID Found -
Hematology (Amsterdam, Netherlands) Dec 2023Primary mediastinal large B-cel l lymphoma (PMBCL) is a rare subtype of B-cell lymphoma that is not yet fully understood. This population-based study aimed to assess the...
OBJECTIVES
Primary mediastinal large B-cel l lymphoma (PMBCL) is a rare subtype of B-cell lymphoma that is not yet fully understood. This population-based study aimed to assess the latest survival and treatment strategies for patients with PMBCL.
METHODS
The study used the dataset from the Surveillance, Epidemiology, and End Results Program registry to retrospectively analyze adult patients diagnosed with PMBCL between 2001 and 2018. The primary outcome measures included overall survival (OS) and disease-specific survival (DSS).
RESULTS
Among the 814 identified cases, the study revealed a 5-year OS rate of 86.7% and a 5-year DSS rate of 88.2% after a median follow-up of 54 months. Cox regression analysis indicated that age over 60 years, pre-2010 diagnosis, non-White ethnicity, advanced stage, and absence of chemotherapy significantly reduced both OS and DSS. It also found that chemotherapy has remained the primary therapeutic protocol for PMBCL over the last 20 years, whereas the utilization of surgery and radiation declined significantly. Patients diagnosed with PMBCL between 2010 and 2018 had a significantly reduced mortality risk (∼50%) compared to those diagnosed between 2001 and 2009. Notably, in the era of rituximab's widespread usage, recipients of radiotherapy exhibited a poorer OS rate than non-recipients.
CONCLUSION
Survival outcomes for patients with PMBCL have significantly improved in the current era, possibly due to the evolving treatment paradigm. The value of radiotherapy in PMBCL is still debated and requires further prospective evaluation.
Topics: Adult; Humans; Middle Aged; Retrospective Studies; Antineoplastic Combined Chemotherapy Protocols; Mediastinal Neoplasms; Lymphoma, B-Cell; Registries; Lymphoma, Large B-Cell, Diffuse
PubMed: 37260259
DOI: 10.1080/16078454.2023.2217396 -
The Journal of Small Animal Practice Jan 2022This retrospective case series describes the clinical presentation and CT findings of dogs with presumed mediastinal haemorrhage with no apparent identifiable underlying...
OBJECTIVE
This retrospective case series describes the clinical presentation and CT findings of dogs with presumed mediastinal haemorrhage with no apparent identifiable underlying cause.
MATERIALS AND METHODS
Medical records were searched for dogs with presumed or suspected mediastinal haemorrhage of non-thymic origin. For all dogs, data on signalment, history, physical examination, treatment and outcome were collected by reviewing the medical records. Follow-up information was collected by telephone interviews with the owners and/or their primary-care veterinarians.
RESULTS
Four dogs were included. All survived to discharge with apparent resolution of the mediastinal haemorrhage (based on repeat imaging and/or clinical signs) with supportive treatment alone. Follow-up information was available from 2 months to 5 years following discharge, and none of the patients showed a recurrence of clinical signs during this period.
CLINICAL SIGNIFICANCE
This case series highlights that presumed haemorrhage into the mediastinum can occur in dogs without an obviously identifiable cause and, whilst rare, should be considered as a cause of dorsal mediastinal masses and may be successfully managed with supportive care alone.
Topics: Animals; Dog Diseases; Dogs; Hemorrhage; Retrospective Studies; Treatment Outcome
PubMed: 33739465
DOI: 10.1111/jsap.13323