Mediastinal Masses: Radiological Point of View

  • Alfonso Reginelli
  • Anna Russo
  • Fernando Scala
  • Elisa Micheletti
  • Roberta Grassi
  • Mario Santini
  • S. Cappabianca
Part of the Current Clinical Pathology book series (CCPATH)


Mediastinal masses are relatively uncommon. When classic features are present, a presumptive diagnosis can be made with a high degree of confidence based on imaging alone. In many instances, localization and characterization of a mediastinal abnormality using multidetector CT are enough to make a diagnosis. A new scheme of division of the mediastinum, based on cross-sectional imaging, has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as the new standard. This new definition plays an important role in the identification and characterization of mediastinal abnormalities, which can often be diagnosed with confidence based on location and imaging features alone.


Mediastinum Mediastinal masses Prevascular compartment Visceral compartment Paravertebral compartment 


  1. 1.
    Carter BW, Okumura M, Detterbeck FC, Marom EM. Approaching the patient with an anterior mediastinal mass: a guide for radiologists. J Thorac Oncol. 2014;9(9 Suppl 2):S110–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: a guide for clinicians. J Thorac Oncol. 2014;9(9 Suppl 2):S102–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44:229–37.CrossRefPubMedGoogle Scholar
  4. 4.
    Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, Rosado-de-Christenson ML, Marom EM. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37(2):413–36. Epub 2017 Jan 27.CrossRefPubMedGoogle Scholar
  5. 5.
    Shields TW. Primary tumors and cysts of the mediastinum. In: Shields TW, editor. General thoracic surgery. Philadelphia: Lea & Febiger; 1983. p. 927–54.Google Scholar
  6. 6.
    Fraser RS, Müller NL, Colman N, Paré PD, editors. The mediastinum. In: Fraser and Paré’s diagnosis of diseases of the chest. 4th ed. Philadelphia: Saunders; 1999. p. 196–234.Google Scholar
  7. 7.
    Fraser RG, Paré PA, editors. The normal chest. In: Diagnosis of diseases of the chest. 2nd ed. Philadelphia: Saunders; 1977. p. 1–183.Google Scholar
  8. 8.
    Felson B. Chest roentgenology. Philadelphia: Saunders; 1973.Google Scholar
  9. 9.
    Heitzman ER. The mediastinum. 2nd ed. New York: Springer; 1988.CrossRefGoogle Scholar
  10. 10.
    Zylak CJ, Pallie W, Jackson R. Correlative anatomy and computed tomography: a module on the mediastinum. RadioGraphics. 1982;2(4):555–92.CrossRefGoogle Scholar
  11. 11.
    Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9(9 suppl 2):S97–S101.CrossRefPubMedGoogle Scholar
  12. 12.
    Fujimoto K, Hara M, Tomiyama N, Kusumoto M, Sakai F, Fujii Y. Proposal for a new mediastinal compartment classification of transverse plane images according to the Japanese Association for Research on the Thymus (JART) General Rules for the Study of Mediastinal Tumors. Oncol Rep. 2014;31(2):565–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosado-de-Christenson ML, Templeton PA, Moran CA. Mediastinal germ cell tumors: radiologic and pathologic correlation. RadioGraphics. 1992;12(5):1013–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Ackman JB, Wu CC. MRI of the thymus. AJR Am J Roentgenol. 2011;197(1):W15–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Ackman JB. MR imaging of mediastinal masses. Magn Reson Imaging Clin N Am. 2015;23(2):141–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Carter BW, Benveniste MF, Truong MT, Marom EM. State of the art: MR imaging of thymoma. Magn Reson Imaging Clin N Am. 2015;23(2):165–77.CrossRefPubMedGoogle Scholar
  17. 17.
    Sung YM, Lee KS, Kim BT, Choi JY, Shim YM, Yi CA. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006;47(10):1628–34.PubMedGoogle Scholar
  18. 18.
    Treglia G, Sadeghi R, Giovanella L, Cafarotti S, Filosso P, Lococo F. Is (18)F-FDG PET useful in predicting the WHO grade of malignancy in thymic epithelial tumors? A meta-analysis. Lung Cancer. 2014;86(1):5–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Jerushalmi J, Frenkel A, Bar-Shalom R, Khoury J, Israel O. Physiologic thymic uptake of 18F-FDG in children and young adults: a PET/CT evaluation of incidence, patterns, and relationship to treatment. J Nucl Med. 2009;50(6):849–53.CrossRefPubMedGoogle Scholar
  20. 20.
    Detterbeck F. Clinical approach to mediastinal masses. In: Kuzdal JML, Muller M, Papagiannopoulos K, et al., editors. ESTS textbook of thoracic surgery. Exeter: European Society of Thoracic Surgeons; 2014.Google Scholar
  21. 21.
    Kim JH, Goo JM, Lee HJ, et al. Cystic tumors in the anterior mediastinum. Radiologic-pathological correlation. J Comput Assist Tomogr. 2003;27:714–23.CrossRefPubMedGoogle Scholar
  22. 22.
    Merolla P, Falchetti A, Filosso P, et al. Thymic neuroendocrine carcinoma (carcinoid) in multiple endocrine neoplasia type 1 syndrome: the Italian series. J Clin Endocrinol Metab. 2005;90:2603–9.CrossRefGoogle Scholar
  23. 23.
    Tomiyama N, Honda O, Tsubamoto M, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol. 2009;69:280–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Inaoka T, Takahashi K, Mineta M, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243:869–76.CrossRefPubMedGoogle Scholar
  25. 25.
    Schaefer NG, Hany TF, Taverna C, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging—do we need contrast-enhanced CT? Radiology. 2004;232:823–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Naidich DP, Webb WR, Muller NL, Krinsky GA, Zerhouni EA, Siegelman SS, editors. Mediastinum. In: Computed tomography and magnetic resonance of the thorax. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999. p. 82–3.Google Scholar
  27. 27.
    Molinari F, Bankier AA, Eisenberg RL. Fat-containing lesions in adult thoracic imaging. AJR Am J Roentgenol. 2011;197(5):W795–813.CrossRefPubMedGoogle Scholar
  28. 28.
    Nasseri F, Eftekhari F. Clinical and radiologic review of the normal and abnormal thymus: pearls and pitfalls. RadioGraphics. 2010;30(2):413–28.CrossRefPubMedGoogle Scholar
  29. 29.
    Kissin CM, Husband JE, Nicholas D, Eversman W. Benign thymic enlargement in adults after chemotherapy: CT demonstration. Radiology. 1987;163(1):67–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L. A diagnostic approach to the mediastinal masses. Insights Imaging. 2013;4(1):29–52.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sirmali M, Turut H, Gezer S, et al. Clinical and radiologic evaluation of foramen of Morgagni hernias and the transthoracic approach. World J Surg. 2005;29:1520–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Rattan KN, Magu S, Rohilla S. Mediastinal foregut duplication cysts. Indian J Pediatr. 2004;71:103–5.CrossRefPubMedGoogle Scholar
  33. 33.
    McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology. 2000;217:441–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Botet JF, Lightdale C. Endoscopic sonography of the upper gastrointestinal tract. AJR Am J Roentgenol. 1991;156:63–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Felson B, Lessure AP. “Downhill” varices of the esophagus. Dis Chest. 1964;46:740–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Kim YJ, Raman SS, Yu NC, To’o KJ, Jutabha R, Lu DSK. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol. 2007;188:139–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Lewis RB, Mehrotra AK, Rodriguez P, Levine MS. From the radiologic pathology archives: esophageal neoplasms: radiologic-pathologic correlation. Radiographics. 2013;33:1083–108.CrossRefPubMedGoogle Scholar
  38. 38.
    Krasna MJ. Radiographic and endosonographic staging in esophageal cancer. Thorac Surg Clin. 2013;23:453–60.CrossRefPubMedGoogle Scholar
  39. 39.
    van Rossum PS, van Hillegersberg R, Lever FM, et al. Imaging strategies in the management of oesophageal cancer: what’s the role of MRI? Eur Radiol. 2013;23:1753–65.CrossRefPubMedGoogle Scholar
  40. 40.
    Kwee RM. Prediction of tumor response to neoadjuvant therapy in patients with esophageal cancer with use of 18F FDG PET: a systematic review. Radiology. 2010;254:707–17.CrossRefPubMedGoogle Scholar
  41. 41.
    Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.CrossRefPubMedGoogle Scholar
  42. 42.
    Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery. 1982;92:1103–8.PubMedGoogle Scholar
  43. 43.
    Upadhye S, Schiff K. Acute aortic dissection in the emergency department: diagnostic challenges and evidence-based management. Emerg Med Clin North Am. 2012;30:307–27.CrossRefPubMedGoogle Scholar
  44. 44.
    Booher AM, Eagle KA. Diagnosis and management issues in thoracic aortic aneurysm. Am Heart J. 2011;162:38–46.CrossRefPubMedGoogle Scholar
  45. 45.
    Bredella MA, Torriani M, Hornicek F, et al. Value of PET in the assessment of patients with neurofibromatosis type 1. AJR Am J Roentgenol. 2007;189(4):928–35.CrossRefPubMedGoogle Scholar
  46. 46.
    Warbey VS, Ferner RE, Dunn JT, Calonje E, O’Doherty MJ. [18F]FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging. 2009;36(5):751–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Restrepo CS, Eraso A, Ocazionez D, Lemos J, Martinez S, Lemos DF. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008;28:1289–305.CrossRefPubMedGoogle Scholar
  48. 48.
    Baleriaux DL, Neugroschl C. Spinal and spinal cord infection. Eur Radiol. 2004;14(Suppl 3):E72–83.PubMedGoogle Scholar
  49. 49.
    Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics. 2000;20:449–70.CrossRefPubMedGoogle Scholar
  50. 50.
    Miles J, Pennybacker J, Sheldon P. Intrathoracic meningocele: its development and association with neurofibromatosis. J Neurol Neurosurg Psychiatry. 1969;32(2):99–110.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Glazer HS, Siegel MJ, Sagel SS. Low-attenuation mediastinal masses on CT. AJR Am J Roentgenol. 1989;152(6):1173–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Kirchner SG, Heller RM, Smith CW. Pancreatic pseudocyst of the mediastinum. Radiology. 1977;123(1):37–42.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Alfonso Reginelli
    • 1
  • Anna Russo
    • 1
  • Fernando Scala
    • 1
  • Elisa Micheletti
    • 1
  • Roberta Grassi
    • 2
  • Mario Santini
    • 3
  • S. Cappabianca
    • 1
  1. 1.Radiology and Radiotherapy Unit, Department of Clinical and Experimental MedicineUniversità degli Studi della Campania “Luigi Vanvitelli”NaplesItaly
  2. 2.Radiotherapy Unit, Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”University of FlorenceFlorenceItaly
  3. 3.Thoracic Surgery Unit, Department of Translational Medical ScienceUniversità degli Studi della Campania ‘Luigi Vanvitelli’NaplesItaly

Personalised recommendations