Mediastinal Mass - Differential Diagnosis Framework Anterior Mediastinal Mass - 5T’s • Thymic neoplasm • Teratoma (or other germ cell tumor) • Thyroid (goiter/neoplasm) • "Terrible" Lymphoma • Thoracic aorta (Aneurysm) Middle Mediastinum: • Vascular masses • Bronchogenic cyst/Tumor • Lymph node hyperplasia • Lymphoma • Pleuropericardial cyst Posterior Mediastinum: • Bronchogenic tumor • Aneurysm • Enteric cyst • Esophageal diverticula/tumor • Neurogenic tumor Mediastinal Tumors: • Anterior Mediastinum - Lymphoma: These malignant tumors include both Hodgkin's disease and non-Hodgkin's lymphoma. - Thymoma and thymic cyst: These are the most common causes of a thymic mass. The majority of thymomas are benign and surrounded by a fibrous capsule. However, about 30% of these may be more aggressive and grow through the sac into other tissue. - Germ cell: The majority of germ cell neoplasms (60 to 70%) are benign and are found in both males and females. - Thyroid mass mediastinal: This is usually a benign growth, such as a goiter. • Middle Mediastinum - Bronchogenic cyst: This is a benign growth with respiratory origins. - Lymphadenopathy mediastinal: This is an enlargement of the lymph nodes. - Pericardial cyst: This is a benign growth that results from an "out-pouching" of the pericardium (the heart's lining). - Tracheal tumors: These can be benign or malignant. - Esophageal tumors: These can be benign or malignant. - Esophageal abnormalities: These include achalasia esophageal, diverticulum, and hiatal hernia. - Vascular abnormalities: These include aortic aneurysm and aortic dissection. • Posterior Mediastinum - Neurogenic tumors: The most common cause of posterior mediastinal tumors, these are classified as nerve sheath neoplasms, ganglion cell neoplasms, and paraganglionic cell neoplasms. Approximately 70% of neurogenic neoplasms are benign. - Lymphadenopathy: This refers to an enlargement of the lymph nodes. - Extramedullary hematopoiesis: This is a rare cause of masses that form from bone marrow expansion and are associated with severe anemia. - Neuroenteric cyst: This is a rare growth that involves both neural and gastrointestinal elements. - Paravertebral abnormalities: These include infections, spinal tumors, and traumatic abnormalities of the thoracic spine. - Vascular abnormalities: These include aortic aneurysms. Mediastinal Mass Symptoms: • Cough • Shortness of breath • Chest pain (somewhat rare) • Flushing • Fever • Chills • Night sweats • Coughing up blood • Hoarseness • Unexplained weight loss • Lymphadenopathy (swollen or tender lymph nodes) • Wheezing • Stridor (high-pitched and noisy breathing, which could mean a blockage) • Eye issues (drooping eyelid, small pupil) on one side of the face #Mediastinal #Mass #Differential #Diagnosis #causes #mediastinum
