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Radiographics : a Review Publication of... 2001Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are... (Review)
Review
Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and fibrous tissue within the mediastinum. Although many cases are idiopathic, many (and perhaps most) cases in the United States are thought to be caused by an abnormal immunologic response to Histoplasma capsulatum infection. Affected patients are typically young and present with signs and symptoms of obstruction or compression of the superior vena cava, pulmonary veins or arteries, central airways, or esophagus. There may be two types of fibrosing mediastinitis: focal and diffuse. The focal type usually manifests on computed tomographic (CT) or magnetic resonance (MR) images as a localized, calcified mass in the paratracheal or subcarinal regions of the mediastinum or in the pulmonary hila. The diffuse type manifests on CT or MR images as a diffusely infiltrating, often noncalcified mass that affects multiple mediastinal compartments. CT and MR imaging play a vital role in the diagnosis and management of fibrosing mediastinitis.
Topics: Fibrosis; Humans; Magnetic Resonance Imaging; Mediastinitis; Prognosis; Tomography, X-Ray Computed
PubMed: 11353121
DOI: 10.1148/radiographics.21.3.g01ma17737 -
La Radiologia Medica Apr 2006Mediastinal tumours are frequently asymptomatic and first noted on routine chest radiograph. In most cases, evaluation should proceed to spiral computed tomography (sCT)... (Review)
Review
Mediastinal tumours are frequently asymptomatic and first noted on routine chest radiograph. In most cases, evaluation should proceed to spiral computed tomography (sCT) of the chest with iodinated contrast material. The specific location and appearance of tumours on sCT is instrumental in planning further diagnostic and treatment strategies. Primary tumours in the anterior mediastinum account for half of all mediastinal masses. They comprise various benign and malignant neoplasms, but a wide variety of nonneoplastic lesions (developmental, inflammatory) can present as a localised mass in this compartment. The most common primary anterior mediastinal tumours are thymoma, teratoma and lymphoma; all other lesions are rare. Nonneoplastic conditions include thymic cysts, lymphangioma and intrathoracic goitre. Understanding the pathology, clinical presentation, imaging and diagnosis of the major tumour types is instrumental in the safe and efficient work-up of a mediastinal mass. Patients with primary mediastinal masses and cysts will usually undergo surgical resection; radiological and clinical features should prompt limited biopsy specimens followed by oncologic consultation, and chemotherapy or radiotherapy when appropriate. The objective of this review was to examine the role of diagnostic imaging in the management of masses of the anterior mediastinum.
Topics: Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Humans; Lymphatic Diseases; Mediastinal Cyst; Mediastinal Diseases; Mediastinal Neoplasms; Mediastinitis; Neoplasms, Germ Cell and Embryonal; Thymus Gland; Tomography, Spiral Computed
PubMed: 16683081
DOI: 10.1007/s11547-006-0032-5 -
Seminars in Cardiothoracic and Vascular... Dec 2020Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior...
Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior mediastinal masses. Studies on posterior mediastinal masses are even more limited in the pediatric population. We present a case of a large posterior mediastinal mass in a 4-year-old child who presented with extremely difficult airway management during endobronchial intubation due to severe external compression that led to use of an adapted airway management technique with a rigid airway exchanger for lung isolation. Due to the pathology of the mass, a tracheal tear was encountered during surgical dissection and the patient required emergent venovenous extracorporeal membrane oxygenation to allow for successful airway repair and complete resection of the mass.
Topics: Airway Management; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Humans; Mediastinal Neoplasms; Mediastinum; Radiography, Thoracic; Tomography, X-Ray Computed; Trachea
PubMed: 32998636
DOI: 10.1177/1089253220960267 -
Respiratory Medicine Sep 2023Paragangliomas are rarely found in the mediastinum, where they account for a small proportion of mediastinal masses. This study aimed to better characterize the...
BACKGROUND
Paragangliomas are rarely found in the mediastinum, where they account for a small proportion of mediastinal masses. This study aimed to better characterize the presenting features and relevant aspects in optimizing the diagnosis and treatment of mediastinal paragangliomas.
METHODS
A computer-assisted search of electronic health records was performed to identify adult patients (≥18 years) who underwent evaluation for a primary mediastinal paraganglioma at Mayo Clinic between January 2000 and April 2022. Medical charts, laboratory tests and radiology images were reviewed to collect data.
RESULTS
The study included 51 patients, each with a single mediastinal paraganglioma. The median age was 47 years (IQR: 39-67), 67% females. Symptoms of catecholamine excess were manifest in 39% of patients, and 14% presented with mass effect, while the remaining 47% had no paraganglioma-related symptoms. Genetic testing was performed in 35 patients; 66% harbored a pathogenic variant in the succinate dehydrogenase enzyme complex. Most paragangliomas (71%) were in the middle mediastinum and showed uptake of intravenous contrast on chest imaging. Biopsies were performed in 30 (59%) patients; 27% were inconclusive and 10% resulted in major complications. Surgical resection occurred in 75%, primarily for relief of symptoms (50%) followed by proximity to critical structures (45%). Perioperative complications were common (66%), but there were no cases of local tumor recurrence during the follow-up period (median 8 years; IQR: 4-13).
CONCLUSION
Mediastinal paragangliomas are most located in the middle mediastinum and can often be diagnosed noninvasively using a combination of clinical, biochemical, and radiological features.
Topics: Adult; Female; Humans; Middle Aged; Male; Retrospective Studies; Paraganglioma, Extra-Adrenal; Paraganglioma; Mediastinal Neoplasms; Mediastinum
PubMed: 37257785
DOI: 10.1016/j.rmed.2023.107296 -
Clinical Techniques in Small Animal... Feb 1998Thoracic surgical oncology involves surgical treatment of lesions of the thoracic wall, pulmonary parenchyma, or mediastinum (also including heart, esophagus, or... (Review)
Review
Thoracic surgical oncology involves surgical treatment of lesions of the thoracic wall, pulmonary parenchyma, or mediastinum (also including heart, esophagus, or trachea). The most common neoplasms of the thoracic wall are osteosarcoma and chondrosarcoma. Histopathologic type, the use of chemotherapy for osteosarcoma, and completeness of surgical margins are prognostic for survival. Relative to solitary pulmonary masses, carcinomas are most common, with histopathologic type, tumor size, tumor grade, and lymph node status prognostic for survival. Of the aforementioned variables, lymph node status is the most significant. Extensive preoperative workup, including bronchoscopy and transthoracic fine needle aspiration of solitary lung masses, is usually not recommended. Thymomas are the most common surgical mediastinal mass. Patients are frequently affected with paraneoplastic syndromes including myasthenia gravis, polymyositis, and nonthymic neoplasia. Patients without megaesophagus with surgically resectable masses have an excellent prognosis for survival. Provision of analgesia after surgery in thoracotomy patients is extremely important. Carefully selected analgesic agents in thoracotomy patients are far less damaging to cardiovascular status than is tachycardia from excessive pain. Given these and other guidelines, perioperative mortality in thoracotomy patients is minimal, and long-term survival in selected patients is excellent.
Topics: Animals; Dog Diseases; Dogs; Guidelines as Topic; Lung; Lung Neoplasms; Mediastinum; Postoperative Care; Prognosis; Surgery, Veterinary; Thoracic Neoplasms; Thoracotomy
PubMed: 9634348
DOI: 10.1016/S1096-2867(98)80027-3 -
Pathologie (Heidelberg, Germany) Jul 2022Mediastinal tumors present a rather rare phenomenon with a variety of underlying causes. Important differential diagnoses include benign and malignant tumors as well...
Mediastinal tumors present a rather rare phenomenon with a variety of underlying causes. Important differential diagnoses include benign and malignant tumors as well as idiopathic sclerosing mediastinitis and parasitic infection.Here, we present the case of a mediastinal pseudotumor with compression of the superior vena cava in a young adult male who spent several years abroad in Brazil. Clinicians suspected either a mediastinal lymphoma, malignant mesenchymal tumor, teratoma, sarcoidosis, or tuberculosis. Biopsy tissue failed to provide a definite diagnosis. The subsequently resected mediastinal mass showed a necrotizing, granulomatous inflammation with prominent eosinophilia and sclerosis. Membranous structures were detected in the necrotic areas, which presented as collagen bundles ultrastructurally. Therefore, these membranes were proven to be constituents of lipid pseudomembranes. Consequently the lesion shows characteristics of sclerosing mediastinitis next to characteristics of adipose tissue necrosis with lipid pseudomembranes. Parasitic infection could not be proven.
Topics: Humans; Lipids; Male; Mediastinal Neoplasms; Mediastinitis; Necrosis; Sclerosis; Vena Cava, Superior; Young Adult
PubMed: 35237866
DOI: 10.1007/s00292-022-01059-3 -
Radiologic Clinics of North America Mar 2021The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on... (Review)
Review
The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on chest radiography and computed tomography, increasing diagnostic specificity, preventing unnecessary intervention, and guiding intervention or surgery when needed. The combination of its higher soft tissue contrast and ability to image dynamically during free breathing, without ionizing radiation exposure, allows more thorough and readily appreciable assessment of a lesion's invasiveness and assessment of phrenic nerve involvement, with significant implications for prognostic clinical staging and surgical management.
Topics: Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Reproducibility of Results
PubMed: 33551086
DOI: 10.1016/j.rcl.2020.11.001 -
Diagnostic and Interventional Imaging Jan 2014
Topics: Aged; Hematopoiesis, Extramedullary; Humans; Image Processing, Computer-Assisted; Incidental Findings; Magnetic Resonance Imaging; Male; Mediastinum; Pulmonary Disease, Chronic Obstructive; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 24012285
DOI: 10.1016/j.diii.2013.07.012 -
Tropical Doctor Oct 2013Mediastinal and lung masses are commonly encountered. The causes range from benign to malignant lesions to which infective lesions contribute to some extent. The...
Mediastinal and lung masses are commonly encountered. The causes range from benign to malignant lesions to which infective lesions contribute to some extent. The conditions presenting as a lung mass with metastatic mediastinal mass are usually indications of malignancy. Tuberculosis is an uncommon cause of such presentations. We report a case of a 53-year-old man who presented with a lung mass with conglomerate lymph nodal mass which was later confirmed as tuberculosis on histopathological examination.
Topics: Diagnosis, Differential; Humans; Lymph Nodes; Male; Mediastinal Diseases; Mediastinum; Middle Aged; Tuberculosis, Pulmonary
PubMed: 24065518
DOI: 10.1177/0049475513502178 -
BMC Surgery Apr 2018The mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue. The differential diagnoses with other diseases such as... (Review)
Review
BACKGROUND
The mediastinal ectopic thyroid is very rare, accounting for less than 1% of all cases of ectopic thyroid tissue. The differential diagnoses with other diseases such as lymphomas, thymic tumors and dermoid cysts is mandatory, in fact each one, needs different management and treatment.
CASE PRESENTATION
Here, we discuss a rare case of mediastinal ectopic thyroid presenting with a paratracheal mass laying on the right bronchus without symptoms. A 63-year-old male presented with an abnormal well-defined mass along the right paratracheal side, detected by chest x-ray. The CT scan confirmed the presence of a 6 × 8 cm heterogeneously enhanced mass, located behind the superior vena cava and left brachiocephalic artery, reaching azygos vein and right bronchus, without a mass effect. Taking into account the clinical importance of a mediastinal mass, we removed it surgically, through a double surgical approach consisting in a classical transverse cervicotomy for the left thyroid lobe, followed then by a longitudinal sternal splitting to remove the mediastinal mass and complete the thyroidectomy.
CONCLUSIONS
In case of mediastinal masses, the surgical excision is recommended, presenting the double advantage to clarify the diagnosis and to treat the pathology. As demonstrated in this case, a mediastinal ectopic thyroid should be taken into account in the differential diagnosis, considering its clinical importance.
Topics: Bronchi; Diagnosis, Differential; Humans; Male; Mediastinum; Middle Aged; Radiography; Thyroid Dysgenesis; Thyroidectomy; Tomography, X-Ray Computed
PubMed: 29618346
DOI: 10.1186/s12893-018-0354-y