-
Seminars in Diagnostic Pathology Mar 2022Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from... (Review)
Review
Acute mediastinitis is a rare infection that carries high morbidity and mortality. They are complications seen most often with deep sternal wound infections from surgeries with median sternotomies, oropharyngeal and odontogenic infections and esophageal perforations. These conditions should be promptly recognized and treated. Mediastinal granulomas are focal, mass-like lesions commonly resulting from prior granulomatous infections. They are regarded as benign, self-resolving lesions however can cause complications by compression of adjacent mediastinal structures. Chronic fibrosing mediastinitis is a rare, diffuse fibroinflammatory process most often seen with granulomatous infections and carries a worse prognosis than mediastinal granulomas especially when adjacent mediastinal structures are compromised. In this review, we discuss the epidemiology, etiology, clinical presentation, treatment and prognosis of acute mediastinitis, mediastinal granulomas, and chronic fibrosing mediastinitis.
Topics: Acute Disease; Granuloma; Humans; Mediastinitis; Mediastinum; Sclerosis
PubMed: 34176697
DOI: 10.1053/j.semdp.2021.06.008 -
Pediatric Radiology Sep 2022Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral... (Review)
Review
Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral compartments. The schema is based on cross-sectional imaging, mainly CT, and helps with generating a differential diagnosis based on location of the mass. Up to half of all pediatric mediastinal tumors are malignant. In this review we describe mediastinal masses that are relevant to the pediatric population, as well as the role of MR imaging of mediastinal masses and its advantages.
Topics: Child; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Tomography, X-Ray Computed
PubMed: 35674800
DOI: 10.1007/s00247-022-05409-4 -
Mediastinum (Hong Kong, China) 2020The mediastinum is the visceral compartment of thoracic cavity divided into the superior and inferior mediastinum, further inferior compartmentalize into anterior,... (Review)
Review
The mediastinum is the visceral compartment of thoracic cavity divided into the superior and inferior mediastinum, further inferior compartmentalize into anterior, middle, and posterior mediastinum. Lymphoma in the mediastinum may be primary or secondary to systemic disease. Lymphoma may arise from lymphoid organs-like thymus, mediastinal lymph nodes or other mediastinal organs like heart, lung, pleura, and pericardium. It comprises about 12% of all the mediastinal tumors in adults however, it constitutes 50% of the pediatric mediastinal mass. Anatomically lymphoma most commonly involves anterior mediastinum. Among the pediatric mediastinal lymphomas, lymphoblastic lymphoma (LBL) predominate followed by Hodgkin lymphoma (HL), primary mediastinal large B cell lymphoma (PMBCL) and very rarely Grey zone lymphoma. Other types of non-HLs (NHLs) are rare among pediatric population. Radiologically and clinically present as an anterior mediastinal mass with symptoms of dyspnea, cough, and superior vena cava syndrome. Also, clinically and radiologically all the pediatric mediastinal mass shares the overlapping features, hence, for treatment and prognostic points of view its essential to differentiate the three entities, i.e., LBL, HL and PMBCL. The pathological diagnosis of pediatric mediastinal lymphomas is quite challenging for general histopathologists. In this review, we describe the pathology, genetics, differential diagnosis, treatment, prognosis, and a simplified histopathological and immunophenotypical approach to differentiate the pediatric mediastinal lymphomas.
PubMed: 35118290
DOI: 10.21037/med-20-37 -
Indian Journal of Thoracic and... Apr 2021The role of extracorporeal membrane oxygenation (ECMO) is expanding as surgeons look at its utility beyond rescue treatment and have started adopting it for high-risk... (Review)
Review
The role of extracorporeal membrane oxygenation (ECMO) is expanding as surgeons look at its utility beyond rescue treatment and have started adopting it for high-risk procedures to provide temporary airway and hemodynamic stabilization. ECMO needs to be deliberated in all patients with mediastinal masses who have compromised airways as well as in those with compression of heart and great vessels. There is a dearth of literature highlighting the definitive role of ECMO in patients with mediastinal masses. This article reviews the available adult literature and highlights the possible situations where the use of ECMO would be supportive in the management of patients with mediastinal masses.
PubMed: 33967453
DOI: 10.1007/s12055-020-01077-x -
Journal of Cancer Research and... 2021Mediastinal masses span a wide histopathological and radiological spectrum. Apart from primary thymic/thyroid masses and lymphomas, all other mediastinal masses can be... (Review)
Review
Mediastinal masses span a wide histopathological and radiological spectrum. Apart from primary thymic/thyroid masses and lymphomas, all other mediastinal masses can be considered rare tumors. Chest radiography and Computed tomography (CT) are helpful to characterize the mass and can reach a diagnosis or a close differential diagnosis. MRI in special situations can depict the pericardial/vascular invasion better, and diffusion studies can recognize benign from the malignant mass. The imaging details of 15 histopathologically proven cases of rare mediastinal tumors are described. Neuroblastoma (NB) (n = 3) was the most common among the rare masses. Three were sarcomas, one liposarcoma, one synovial sarcoma, one spindle-cell tumor and one Hemangiopericytoma (HPC). Lymphoma presenting as a single mass, neuroendocrine tumor (NET) of the anterior mediastinum, paraganglioma of the posterior mediastinum (one each) were seen.The imaging features of these rare mediastinal masses have to be kept in mind for appropriate diagnosis.
Topics: Humans; Lymphoma; Magnetic Resonance Imaging; Mediastinal Neoplasms; Neuroblastoma; Thymus Neoplasms; Thyroid Neoplasms; Tomography, X-Ray Computed
PubMed: 33723126
DOI: 10.4103/jcrt.JCRT_587_19 -
Mediastinum (Hong Kong, China) 2023A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their... (Review)
Review
A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their mimics. Localization of a mediastinal lesion to a compartment and characterization of morphology, density/signal intensity, enhancement, and mass effect on neighboring structures can help narrow the differentials. The International Thymic Malignancy Interest Group (ITMIG) established a cross-sectional imaging-derived and anatomy-based classification system for mediastinal compartments, comprising the prevascular (anterior), visceral (middle), and paravertebral (posterior) compartments. Cross-sectional imaging is integral in the evaluation of mediastinal lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to characterize mediastinal lesions detected on radiography. Advantages of CT include its widespread availability, fast acquisition time, relatively low cost, and ability to detect calcium. Advantages of MRI include the lack of radiation exposure, superior soft tissue contrast resolution to detect invasion of the mass across tissue planes, including the chest wall and diaphragm, involvement of neurovascular structures, and the potential for dynamic sequences during free-breathing or cinematic cardiac gating to assess motion of the mass relative to adjacent structures. MRI is superior to CT in the differentiation of cystic from solid lesions and in the detection of fat to differentiate thymic hyperplasia from thymic malignancy.
PubMed: 37701642
DOI: 10.21037/med-22-53