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



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