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The mediastinum has three main parts: the anterior mediastinum (front), the middle mediastinum, and the posterior mediastinum (back). Masses in the anterior portion of the mediastinum can include thymoma, lymphoma , pheochromocytoma , germ cell tumors including teratoma , thyroid tissue, and parathyroid lesions.
The diagnosis of a mediastinal germ cell tumor should be considered in all young males with a mediastinal mass. In addition to physical examination and routine laboratory studies, initial evaluation should include CT of the chest and abdomen, and determination of serum levels of HCG and alpha-fetoprotein.
This PA chest radiograph demonstrates an abnormal contour in the right hilar region, with visualization of the pulmonary vessels through the mass (the hilar overlay sign) indicating its posterior mediastinal location. On resection this was found to be a benign solitary fibrous tumor of the pleura.
Primary mediastinal B-cell lymphoma, abbreviated PMBL or PMBCL, is a rare type of lymphoma that forms in the mediastinum (the space in between the lungs) and predominantly affects young adults. [ 1 ] [ 2 ] [ 3 ]
Micrograph of a primary mediastinal large B-cell lymphoma, a cause of mediastinal lymphadenopathy. H&E stain. Mediastinal lymphadenopathy or mediastinal adenopathy is an enlargement of the mediastinal lymph nodes.
[2] [7] Pericardial cysts make up 6-7% of all mediastinal masses. [ 2 ] [ 3 ] They can present at any age, but are most commonly diagnosed between the third and fifth decade of life. [ 2 ] [ 3 ] Females and males have approximately equal incidences of pericardial cysts.
Mediastinal shift is an abnormal movement of the mediastinal structures toward one side of the chest cavity. A shift indicates a severe imbalance of pressures inside the chest. [ 1 ] Mediastinal shifts are generally caused by increased lung volume, decreased lung volume, or abnormalities in the pleural space.
Chronic sclerosing (or fibrosing) mediastinitis, while potentially serious, is caused by a long-standing inflammation of the mediastinum, leading to growth of acellular collagen and fibrous tissue within the chest and around the central vessels and airways. It has a different cause, treatment, and prognosis than acute infectious mediastinitis.