Volumetric formations of the mediastinum

The voluminous mediastinal formations are represented by various cysts and tumors; the probable causes of them depend on the age of the patient and the localization of education in the anterior, middle or posterior mediastinum.

Education may be asymptomatic (in adults) or cause obstruction of the respiratory tract (in children). When diagnosing, CT is used, a biopsy of education and, if necessary, additional studies. Treatment of volumetric mediastinal masses is determined by the cause of the disease.

What causes the bulk formation of the mediastinum?

The volumetric mediastinal formations are divided into those located in the anterior, middle and posterior mediastinum. In each of these spaces there are characteristic volumetric formations. The anterior mediastinum is limited to the sternum (in front), the pericardium and the brachiocephalic vessels (posterior). The mediastinal mediastinum is between the anterior and posterior mediastinum. The posterior mediastinum is limited by the pericardium and trachea (front) and the spine (posterior).

The most frequent mediastinal formations in children are neurogenic tumors and cysts. In adults, neurogenic tumors and thymomas are the most frequent formations of the anterior mediastinum; lymphoma (Hodgkin's and non-Hodgkin's are some) are most common in patients aged 20 to 40 years in the anterior mediastinum.

Symptoms of mediastinal formations

Symptoms of mediastinal formations depend on their localization. Many are asymptomatic. Malignant tumors are much more often accompanied by the development of clinical symptoms than benign tumors. The most common symptoms of mediastinal formation are chest pain and weight loss. In children, mediastinal tumors are most likely to cause compression of the trachea and bronchi and stridor or recurrent bronchitis or pneumonia. The formation of anterior mediastinum of large size can cause dyspnoea in the supine position on the back. Formations of the mediastinal mass can squeeze blood vessels or the respiratory tract, leading to the development of an upper vena cava syndrome or airway obstruction. The formation of the posterior mediastinum can squeeze the esophagus or germinate into it, leading to the development of dysphagia or loneliness.

Diagnosis of mediastinal formations

Volumetric mediastinal formations are most often found by chance in chest X-ray or other radiation studies undertaken for clinical symptoms from the chest. Additional diagnostic studies, usually radiotherapy and biopsy, are performed to determine the type of education.

Differential diagnosis of volumetric mediastinal formations

Age	Front	Average	Rear
Adults	Aneurysm of the anterior aortic semicircle Ectopic thyroid tissue Lymphoma Hernial opening Morganyi Cyst of pericardium Teratoma Timoma	Unpaired vein Bronchogenic cyst Ectopic thyroid tissue Anomalies of the esophagus Hernia of the esophagus of the diaphragm Lymphadenopathy Varicose veins Vascular aneurysm	Aneurysm of the descending aorta Neurogenic tumors Infection of paravertebral tissues
Children	Ectopic thyroid gland Lymphoma Sarcoma Teratoma Thymus: Cyst Histiocytosis Histoplasmosis Norm Tima	Bronchogenic cyst Tumor of the heart Hygroma Doubling of the esophagus Hemangioma Lymphadenopathy Lymphoma Cyst of the pericardium Vascular anomalies	Meningomielocele Neuroenterogenic abnormalities Neurogenic tumors

CT with intravenous contrast is the most informative visualization method. With CT of chest organs, normal structures and benign tumors, particularly fatty ones, and fluid-filled cysts can be differentiated from other processes with a high degree of confidence. A reliable diagnosis can be established in many formations of the mediastinum as a result of a thin-needle aspiration or thick-needle biopsy. A fine needle aspiration biopsy is usually sufficient for malignant processes, but with the suspicion of lymphoma, thymoma or a neural tissue tumor, it is almost always necessary to perform a thick-needle biopsy. If tuberculosis is suspected, a tuberculin test is performed. If suspected of an ectopic thyroid tissue, a study is made of the concentration of thyroid-stimulating hormone.

[1], [2], [3], [4], [5], [6],

Treatment of mediastinal formations

Treatment of volumetric mediastinal formations depends on the type of volumetric formation. Some benign formations, in particular pericardial cysts, can simply be observed. Most malignant tumors should be surgically removed, but in some, particularly with lymphomas, chemotherapy is advisable. For granulomatous diseases adequate antimicrobial therapy should be conducted.