Skip to main content

Benign and Malignant Mediastinal Lesions

  • Chapter
Radiologic Diagnosis of Chest Disease
  • 231 Accesses

Abstract

From the beginning of this century until the early 1950s, mediastinal masses were treated by radiation therapy, by clinical and radiological follow-up, and less often by surgery (1,2). Between 1950 and 1960 surgery alone became more important, not only for treatment, but also for the diagnosis of mediastinal masses (3). Many authors agreed that thoracotomy must be performed once a mediastinal mass has been diagnosed, especially because many are potentially malignant (4,5). Recently, and with the help of new radiological techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), the cause of mediastinal widening has been diagnosed with a much greater level of certainty. Needle biopsy techniques used in everyday routine diagnosis are very suitable for mediastinal lesions and are easily performed with the help of ultrasound and CT. A chest diagnostic thoracotomy is now seldom used in most institutions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Blades B: Mediastinal tumors: Report of cases treated at Army Thoracic Surgery Center in the United States. Ann Surg 123:749–765, 1946

    Article  Google Scholar 

  2. Thomson JV: Mediastinal tumors and cysts. Int Abstr Surg 84:195–221,1947

    Google Scholar 

  3. Lyons HA, Calvy GL, Sammons BP: The diagnosis and classification of mediastinal masses. 1. A study of 782 cases. Ann Intern Med 51:897–932, 1959

    PubMed  CAS  Google Scholar 

  4. Wychulis AR, Payne WS, Clagett OT, Woolner LB: Surgical treatment of mediastinal tumors: A 40 years experience. J Thorac Cardiovasc Surg 62:379–392, 1971

    PubMed  CAS  Google Scholar 

  5. Benjamin SP, McCormack LJ, Effler DB, Groves LK: Primary tumors of the mediastinum. Chest 62:297–303 1972

    Article  PubMed  CAS  Google Scholar 

  6. Felson B: Chest Roentgenology. Philadephia, WB Saunders Co., 1973

    Google Scholar 

  7. Heitzman ER: The Mediastinum. Radiologic Correlations with Anatomy and Pathology. St. Lous, CV Mosby, 1977

    Google Scholar 

  8. Fraser RP, Pare JA: Diagnosis of Disease of the Chest ed 2. Philadelphia, WB Saunders Co, 1978

    Google Scholar 

  9. Bein ME, Spiegler P, Rigler LG: High kVp chest radiography. AJR 129: 1138–1139, 1977

    PubMed  CAS  Google Scholar 

  10. Revesz G, Shea FJ, Kundel HL: The effects of kilovoltage on diagnostic accuracy in chest radiography. Radiology 142:615–618, 1982

    PubMed  CAS  Google Scholar 

  11. Woodring JH, Daniel TL: Mediastinal Analysis Emphasizing Plain Radiographs and Computed Tomograms. Medical Radiography and Photography 62, No 1. Eastman Kodak Company, 1986

    Google Scholar 

  12. Herlitzka AJ, Gale JW: Tumors and cysts of the mediastinum. Arch Surg 76:697–706, 1958

    Article  CAS  Google Scholar 

  13. Baron RL, Levitt RG, Sagel SS, Stanley RJ: Computed tomography in the evaluation of mediastinal widening. RadioloRY 138:107–113,1981

    CAS  Google Scholar 

  14. de Geer G, Webb WR, Gamsu G: Normal thymus: Assessment with MR and CT. Radiology 158:313–317, 1986

    PubMed  Google Scholar 

  15. Moore AV, Korobkin M, Olanow W, KHeaston DK, Ram PC, Dunnick NR, Silverman PM: Age-related changes in the thymus gland: CT-pathologic correlation. AJR 141:241–246, 1983

    PubMed  CAS  Google Scholar 

  16. Levine GD, Rosai J: Thymic hyperplasia and neoplasia: A review of current concepts. Hum Pathol 9:495–515, 1978

    Article  PubMed  CAS  Google Scholar 

  17. Rosai J, Levine GD: Tumors of the thymus. In: Atlas of Tumor Pathology Fascicle 13. Washington, DC, Armed Forces Institute of Pathology, 1976

    Google Scholar 

  18. Fon GT, Bein ME, Mancuso AA, Keesey JC, Lupetin AR, Wong WS: Computed tomography of the anterior mediastinum in myasthenia gravis. Radiology 142: 135–141,1982

    Google Scholar 

  19. Yeh HC, Gordon A, Kirchner PA, Cohen BA: Computed tomography and sonography of thymolipoma. AJR 140:1131–1133,1983

    PubMed  CAS  Google Scholar 

  20. Baron RL, Lee JKT, Sagel SS, Peterson RR: Computed tomography of the normal thymus. Radiology 142:121–125, 1982

    Google Scholar 

  21. Heiberg E: Standard for normal thickness of the thymus gland. Radiology 147:887, 1983

    PubMed  CAS  Google Scholar 

  22. Lemaitre L, Remy J, Saint-Michel J: Masses ou pseudomasses mediastinales, in Vasile N (ed): Tomodensitometrie Corps Entier. Paris, Vigot, 1985

    Google Scholar 

  23. Heiberg E, Wolferson MK, Sundaram M, Nouri S: Normal thymus: CT characteristics in subjects under age 20. AJR 138:491–494, 1982

    PubMed  CAS  Google Scholar 

  24. Baron RL, Lee JKT, Sagel SS, Levitt RG: Computed tomography of the abnormal thymus. Radiology 142:127 -134, 1982

    PubMed  CAS  Google Scholar 

  25. Kristin H: The thymus gland, in Symmers W St C (ed): Systemic Pathology. Edinburgh, Churchill Livingstone, 1976, pp 893–924

    Google Scholar 

  26. Moss AA, Gamsu G, Genant HK: Computed Tomography of the Body. Philadelphia, WB Saunders Co, 1983

    Google Scholar 

  27. Livesay JJ, Mink JH, Free JH, Bein ME, Sample WF, Mulder DG: The use of computed tomography to evaluate suspected mediastinal tumors. Ann Thorac Surg 27:305, 1979

    Article  PubMed  CAS  Google Scholar 

  28. Lemaitre L, Gosselin B, Smith M, Ramon Ph, Lafitte JJ, Servais B, Remy J: Localisations abdominales des thymomes invasifs. J Radiol 63:485–494, 1982

    PubMed  CAS  Google Scholar 

  29. Naidlich DP, Zerhouni EA, Siegelman SS: Computed Tomography of the Thorax. New York, Raven Press, 1984

    Google Scholar 

  30. Lindfors KL, Meyer JE, Dedrick CG, Hassell LA, Harris NL: Thymic cysts in mediastinal Hodgkin disease. Radiology 156:37–41,1985

    PubMed  CAS  Google Scholar 

  31. Baron RL, Sagel SS, Baglan RJ: Thymic cysts following radiation therapy for Hodgkin disease. Radiology 141:593–597,1981

    PubMed  CAS  Google Scholar 

  32. Dunne MG, Weksberg AP: Thymic cyst: Computed tomography and ultrasound correlation. JCAT 7:351–355, 1983

    CAS  Google Scholar 

  33. Mancuso L, et al: Echographic recognition of mediastinal masses. Chest 93:144–148,1988

    Article  PubMed  CAS  Google Scholar 

  34. Kuhlman JE, Fishman EK, Wang KP, Zerhouni EA, Siegelman SS: Mediastinal cysts: Diagnosis by CT and needle aspiration. AJR 150:75–78, 1988

    PubMed  CAS  Google Scholar 

  35. Wernecke K, Potter R, Peters PE, Koch P: Parasternal mediastinal sonography: Sensitivity in the detection of anterior mediastinal masses. AJR 150:1021–1026, 1988

    PubMed  CAS  Google Scholar 

  36. Holford CP, Begent RHJ, Newlands ES, Rusin GJS, Makey AR, Bagshawe 0: Effective treatment for malignant mediastinal teratomas. Thorax 38:897–902, 1983

    Article  PubMed  Google Scholar 

  37. Harrison TR: Harrison’s Principles of Internal Medicine ed 7. New York, McGraw-Hill Book, 1974, Chap 271

    Google Scholar 

  38. Susuki M, Takashima T, Hoh H, Choutoh S, Kawamura I, Watanabe Y: Computed tomography of mediastinal teratomas. JCAT 7:74–76, 1983

    Google Scholar 

  39. Lewis BD, Hurt RD, Payne WS, Farrow GM, Knapp RH, Muhm JR: Benign teratomas of the mediastinum. J Thorac Cardiovasc Surg 86:727–731,1983

    PubMed  CAS  Google Scholar 

  40. Steinmetz WH, Hays RA: Primary seminoma of the mediastinum. AJR 86:669–672, 1961

    Google Scholar 

  41. Levitt RG, Husband JE, Glazer HS: CT of primary germcell tumors of the mediastinum. AJR 142:73–78, 1984

    PubMed  CAS  Google Scholar 

  42. Davis JM, Mark GJ, Greene R: Benign blood vascular tumors of the mediastinum. Radiology 126:581–587, 1978

    PubMed  CAS  Google Scholar 

  43. Angtuaco EJC, Kimenez JF, Burrows P, Ferris E: Lymphatic-venous malformation (lymphangiohemangioma) of the mediastinum. JCAT 7:895–897, 1983

    CAS  Google Scholar 

  44. Komaiko MS, Lee ME, Birnberg FA: The contrast enhanced paravascular neoplasm: A potential CT pitfall. JCAT 4:516, 1980

    CAS  Google Scholar 

  45. Judd ES, Beahrs OH, Bowes DE: A consideration of the proper surgical approach for substernal goiter. Surg Gynecol Obstet 110:90, 1960

    PubMed  CAS  Google Scholar 

  46. Glazer GM, Axel L, Moss AA: CT diagnosis of mediastinal thyroid. AJR 138:495–498, 1982

    PubMed  CAS  Google Scholar 

  47. Brennan MF, Doppman JL, Marx SJ, Spiegel AM, Brown EM, Aurback GD: Reoperative parathyroid surgery for persistant hyperparathyroidism. Surgery 83: 669–676, 1978

    PubMed  CAS  Google Scholar 

  48. Krudy AG, Doppman JL, Brennan MF, Marx SJ, Spigel AM, Stock JL, Aurbach GD: The detection of mediastinal parathyroid glands by computed tomography, selective arteriography, and venous sampling. Radiology 140:739, 744, 1981

    Google Scholar 

  49. Sechtem U, Tscholakoff D, Higgins CB: MRI of the abnormal pericardium. AJR 147:245, 1986

    PubMed  CAS  Google Scholar 

  50. Genereux G, Howie JL: Normal mediastinal lymph node size and number: CT and anatomic study. AJR 142: 1095–1100, 1984

    PubMed  CAS  Google Scholar 

  51. Libshitz HI, McKenna RK Jr, Haynie TP, McMurthrey MJ, Mountain CT: Mediastinal evaluation in lung cancer. Radiology 151:295–299, 1984

    PubMed  CAS  Google Scholar 

  52. Faling LJ, Pugatch RD, Jung-Legg Y, Daly BDT, Hong WK, Robbins AH, Snider GL: Computed tomography scanning of the mediastinum in the staging of bronchogenic carcinoma. Am Rev Respir Dis 124:690–695, 1981

    PubMed  CAS  Google Scholar 

  53. McLoud TC, Kalisher L, Stark P, et al: Intrathoracic lymph node metastases from extrathoracic neoplasms. AJR 140:403–407, 1978

    Google Scholar 

  54. Webb WR, Jensen BG, Sollitto R, de Geer G, McCowin M, Gamsu G, Moore EH: Bronchogenic carcinoma: Staging with MR compared with staging with CT and surgery. Radiology 156: 117, 1985

    PubMed  CAS  Google Scholar 

  55. Dooms GC, Hricak H, Crooks LE, Higgins CB: Magnetic resonance imaging of the lymph nodes: Comparison with CT. Radiology 153:719–728, 1984

    PubMed  CAS  Google Scholar 

  56. Reed JC, Hallet KK, Feigin DS: Neural tumors of the thorax: Subject review from the AFIP.Radiology 126:9-17,1978

    PubMed  CAS  Google Scholar 

  57. Kumar A, Kuhajda P, Martinez CR, Fishman EK, Jezic DV, Siegelman SS: Computed tomography of extracranial nerve sheath tumors with pathological correlation. JCAT 7:857–865, 1983

    CAS  Google Scholar 

  58. Armstrong EA, Harwood Nash DCF, Ritz C, Chuang SH, Petterson H, Martin DJ: CT of neuroblastomas and ganglioneuromas in children. AJR 139:571–576, 1982

    PubMed  CAS  Google Scholar 

  59. Stark DD, Moss AA, Brasch RC, De Lorimier AA, Albin AR, London DA, Gooding CA: Recurrent neuroblastoma. Radiology 148:107–112, 1983

    PubMed  CAS  Google Scholar 

  60. Picus D, Balfe DM, Koelher RE, Roper CL, Owen JW: Computed tomography in the staging of esophageal carcinoma. Radiology 146:433–438, 1983

    PubMed  CAS  Google Scholar 

  61. Terrier F, Schapria C, Fuchs WA: CT assessment of operability in carcinoma ofthe esophagogastric junction. Radiology 154:567,1985

    Google Scholar 

  62. Halvorsen RA Jr, Magruder-Habib K, Foster WL Jr, Roberts L Jr, Postlethwait RW, Thompson WM: Esoph- ageal cancer staging by CT: Long-term follow-up study. Radiology 161: 147, 1986

    PubMed  Google Scholar 

  63. Quint LE, Glazer GM, Orringer MB: Esophageal imaging by MR and CT: Study of normal anatomy and neoplasms. Radiology 156:727, 1985

    PubMed  CAS  Google Scholar 

  64. Holt J: Epipericardial fat shadows in differential diagnosis. Radiology 48:472–479, 1947

    PubMed  CAS  Google Scholar 

  65. Dooms GC, Hricak H, Sollitto RA, Higgins CB: Lipomatous tumors and tumors with fatty component: MR imaging. Potential and comparison of MR and CT results. Radiology 157:479–483, 1985

    PubMed  CAS  Google Scholar 

  66. Pugatch RD, Braver JH, Robbins AH, Faling LJ: CT diagnosis of pericardial cysts. AJR 131:515–516, 1978

    PubMed  CAS  Google Scholar 

  67. Ramenofsky ML, Leape LL, McCauley RGK: Bronchogenic cysts. J Pediatr Surg 14:219–224, 1979

    Article  PubMed  CAS  Google Scholar 

  68. Reed JC, Sobonya RE: Morphologic analysis offoregut cysts in the thorax. AJR 120:851, 1974

    CAS  Google Scholar 

  69. Sirivella S, Ford WB, Zikria EA, et al: Foregut cysts of the mediastinum: Results in 20 consecutive surgically treated cases. J Thorac Cardiovasc Surg 90:776–782, 1985

    PubMed  CAS  Google Scholar 

  70. Kirwan WO, Walbaum PR, McCormack RJM: Cystic intrathoracic derivatives of the foregut and their complications. Thorax 28:424–428, 1973

    Article  PubMed  CAS  Google Scholar 

  71. Mendelson DS, Rose JS, Efremidis SC, Kirschner PA, Cohen BA: Bronchogenic cysts with high CT numbers. AJR 140:463–465, 1983

    PubMed  CAS  Google Scholar 

  72. Yernault JC, Kuhn G, Dumortier P, Rocmans P, Ketelbant P, de Vuyst P: “Solid” mediastinal bronchogenic cyst: Mineralogic analysis. AJR 146:73–74, 1986

    PubMed  CAS  Google Scholar 

  73. Morettin LB, Allen TE: Thoracic duct cyst: Diagnosis with needle aspiration. Radiology 161:437–438, 1986

    PubMed  CAS  Google Scholar 

  74. Pilla TJ, Wilverson MK, Sundaram M, Heiberg E, Shields JB: CT evaluation of cystic lymphangiomas of the mediastinum. Radiology 144:841–842, 1982

    PubMed  CAS  Google Scholar 

  75. Daehnert W, Schild H, Guenther R, Rothmund M: Computerized tomography of a mediastinal pancreatic pseudocyst. Eur J Radiol 3:375–377, 1983

    PubMed  CAS  Google Scholar 

  76. Miles J, Penny backer J, Sheldon P: Intrathoracic meningocele. Its development and association with neurofibromatosis. J Neurol Neurosurg Psychiatry 32:99, 1969

    Article  PubMed  CAS  Google Scholar 

  77. Da Costa JL, Loh YS, Hanam E: Extramedullary hemopoiesis with multiple tumor-simulating mediastinal masses in hemoglobin E-thalassemia disease. Chest 65:210–212, 1974

    Article  CAS  Google Scholar 

  78. Ross P, Logan W: Roentgen findings in extramedullary hematopoiesis. Am J Roentgenol Rad Ther Nucl Med 106:604, 1969

    CAS  Google Scholar 

  79. Long JA, Doppman JL, Nienhuis A W: Computed tomography studies of thoracic extramedullary hematopoiesis. JCAT 4:67–70, 1980

    Google Scholar 

  80. Homer MJ, Wechsler RJ, Carter BL: Mediastinallipomatosis: CT confirmation of a normal variant. Radiology 128:657–661, 1978

    PubMed  CAS  Google Scholar 

  81. Weinstein JB, Aronberg DJ, Sagel SS: CT of fibrosing mediastinitis: Findings and their utility. AJR 141:247–251, 1983

    PubMed  CAS  Google Scholar 

  82. Rholl KS, Levitt RG, Glazer HS: Magnetic resonance imaging of fibrosing mediastinitis. AJR 145:255–259, 1985

    PubMed  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Springer-Verlag New York Inc.

About this chapter

Cite this chapter

de Geer, G. (1990). Benign and Malignant Mediastinal Lesions. In: Sperber, M. (eds) Radiologic Diagnosis of Chest Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4684-0347-3_35

Download citation

  • DOI: https://doi.org/10.1007/978-1-4684-0347-3_35

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4684-0349-7

  • Online ISBN: 978-1-4684-0347-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics