Diagnostic approach to mediastinal masses (original) (raw)
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CT Evaluation of Mediastinal Masses
Journal of Evidence Based Medicine and Healthcare
BACKGROUND The mediastinum is demarcated by the pleural cavities laterally, the thoracic inlet superiorly and the diaphragm inferiorly. It is further divided into anterior, middle and posterior compartments by many anatomists. 1 CT imaging allows early diagnosis and more specific characterization of anterior mediastinal masses than is possible with plain film radiographs. This study describes state-of-the-art CT imaging of the mediastinum. 1 Detection, diagnosis, staging, and follow-up of anterior mediastinal masses is important and has been significantly improved with CT imaging.
Diagnosis and Treatment of Mediastinal Tumors by Thoracoscopy
Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventythree patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). Results: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusion: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.
Applied Radiology Imaging of the mediastinum in oncology
Disclosures Appl Radiol. 2007;36(1) With the wide variety of mediastinal anatomic structures, tumors in this area include a heterogeneous group of primary and metastatic neoplasms. Most mediastinal abnormalities are detected on routine chest radiography, but further radiologic evaluation involves computed tomography (CT) or magnetic resonance imaging and may use positron emission tomography (PET) or integrated PET/CT. The authors review findings of mediastinal abnormalities as seen on a range of imaging modalities. The mediastinum is composed of various structures within the central portion of the thorax that are bounded by the lungs, the diaphragm, and the thoracic inlet. Because of this wide variety of anatomic structures, mediastinal tumors constitute a heterogeneous group of neoplasms, both primary and metastatic. Detection of mediastinal abnormalities requires familiarity with the chest radiograph, as most mediastinal tumors are discovered in asymptomatic patients on routine chest radiography. Once a mediastinal abnormality is detected by a chest radiograph, further radiologic evaluation involves cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) and may employ other imaging techniques, such as positron emission tomography (PET) or integrated PET/CT. This article will review fundamental radiologic findings of mediastinal abnormalities on chest radiographs and will address the salient features of mediastinal tumors on other imaging modalities, including CT, MRI, PET, and integrated PET/CT.Continue Reading The diagnostic evaluation of mediastinal disease requires a thorough understanding of mediastinal anatomy on chest radiography and cross-sectional imaging. Localizing and understanding the relationship of an abnormality to a mediastinal compartment or normal structure can provide a valuable clue for the diagnosis of a mediastinal mass. The chest radiograph is the most often performed radiographic examination, constituting more than 40% of the total volume of radiographs, with >50 million chest radiographs performed per year in the United States. [1] Therefore, it is important for radiologists to understand the appearance of normal structures and how they can be altered by disease. In particular, the detection of mediastinal disease can be difficult with conventional chest
Diagnosis and Treatment of Mediastinal Tumors by Thoracoscopy*
CHEST Journal, 2000
Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventythree patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). Results: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusion: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.
A diagnostic approach to the mediastinal masses
Insights into Imaging, 2012
Background Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis. Methods Radiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another. Results Tissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases. Conclusion Familiarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment. Teaching Points • CT and MRI are important for the diagnosis of mediastinal masses. • The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses. • Symptomatology and patient age affect the likelihood of malignancy.
CT Evaluation of Mediastinal Masses : A Study of 80 Cases
2018
Eighty patients with mediastinal masses were imaged with computed tomography (CT). Results were analyzed with regard to the ability of CT to demonstrate the masses, their location, their morphology, and their encroachment upon or displacement of adjacent mediastinal structures. CT images were compared with plain chest radiographs which were available in all cases. CT depicted all lesions successfully with good anatomic detail. Among the 80patients the largest number of cases (n =51) were found to be having lymphadenopathy with Hodgkin's lymphoma in 57% and non-Hodgkin's lymphoma in J5% of cases. CT is regarded as the best single radiological investigation for evaluating a mediastinal abnormality demonstrated on a high-kV chest radiograph or for detecting occult mediastinal disease.
The thoracoscope as diagnostic tool for solid mediastinal masses
Surgical Endoscopy, 1996
Background: Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those tumors requiring an immunological classification. Methods: The thoracoscopic approach to mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy, or anterior mediastinotomy. The procedure is performed under general anesthesia and one-lung ventilation. Results: In a series of 47 cases, a histological diagnosis was obtained in 44 cases (93.6%). There was one hemorrhagic complication requiring thoracotomy (2.1%). The mean postoperative duration of stay was 3.2 days. Conclusions: Thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy in treating paratracheal lymph nodes.
National Journal of Medical Research, 2019
Introduction: The studies are not limited to xrays only in this modern radiological era. Since xrays have their own limitations, CT study has made things easier and handy. CT is very much useful in detailing the pathologies of mediastinal lesions. The advent of contrast in CT revelutionizes the evaluation of Mediastinal pathologies. CT also helps in studying in characteristics and nature of masses with involvement of adjacent structures. Additional role of CT scan is to take biopsy of mass lesions and then correlate the CT diagnosis with histopathological diagnosis Material and methods:All the Patients referred in dept of radiodiagnosis, govt medical college and new civil hospital, Surat for clinically suspected mediastinal pathologies and suspected mediastinal lesions on chest X-ray undergone plane or contrast enhanced computed tomography scan (CECT) or both after proper counselling about the procedure and after taking the written consent. Prospective study of all 40 patients done from October 2017 to august 2018 and CT findings were correlated with histopathological diagnosis. Results: In our study, anterior mediastinum was the most commonly involved compartment, followed by superior mediastinum, posterior mediastinum and middle mediastinum. Lymphoma and thymic lesions are most common lesions in anterior and superior mediastinum. Teratoma and metastatic lymphadenopathy in middle mediastinum and neurogenic tumour like schwannoma in posterior mediastinum. Out of 38 patients who undergone biopsy, histopathology report of 35 patients indicates same diagnosis as indicated by CECT (diagnostic accuracy 87.5%). Conclusion: From the above results, we conclude that computed tomography definitely has a major role to play in evaluation of a mediastinal mass regarding the compartmental distribution, mass effect and provisional diagnosis which was correlated with histopathological diagnosis.
A case series of mediastinal masses
Annals of Tropical Medicine and Public Health, 2021
Introduction: The majority of mediastinal masses are discovered incidentally. At least half of all mediastinal masses are asymptomatic and detected by chest radiography performed for unrelated reasons. Primary lesions of the mediastinum are less common than lesions that secondarily involve the mediastinum.This case series discuss and highlight the varied presentations, different diagnostic modalities available in establishing the diagnosis of mediastinal masses. The importance and the role of performing immunohistochemistry staining in establishment of final diagnosis and planning of management are also highlighted.
Thoracic Radiology
The radiologic evaluation of mediastinal masses is complex and requires a thorough knowledge of the anatomy and compartments of the mediastinum. Although in most cases the diagnosis of mediastinal masses is incidental, especially in the anterior mediastinum, whenever a clinical suspicion exists a standard CXR still remains the first imaging modality used. It allows to evaluate any deformation of the mediastinal profile and displacement of the normal anatomical structures. In some cases, a chest X-ray permits to characterize the location and type of mediastinal lesions; however a CT scan is deemed necessary for significant radiographic alterations.