VA Intern Report Holly Smith Edition-Mediastinal masses and lymphadenopathy

Hey all,

Thanks to all who participated in our intern report this week with visiting professor Dr. Katrina Armstrong, you were gracious hosts and a gracious audience. Thanks also to Kapil for one of the cases of the year, completely unplanned! We had a couple cases this week involving mediastinal masses so thought I’d highlight some key points on the evaluation of mediastinal masses.

#Mediastinum: The space between the lungs, literally. We can divide it into three compartments:

  • Anterior mediastinum-most common spot to find masses in adults, extends from the posterior sternum to the anterior pericardium/great vessels, this is also where the “terrible t’s” live: teratoma/germ cell tumor, thymoma/thymic mass, (ectopic) thyroid tissue, lymphoma (TERRIBLE lymphoma, also why CVG gives the side eye to mnemonics)
  • Middle mediastinum-encompasses the heart, great vessels, esophagus, all the way to the ventral surface of the t-spine. Lymphadenopathy comprises most middle mediastinal masses, can also find benign cystic masses here too.
  • Posterior mediastinum-T-spine including rib facet joints, important to note the sympathetic chain ganglion and Thoracic nerve roots live here so we can see malignant and benign neurogenic tumors here. T-spine masses like mets can show up in the posterior mediastinum, rarely meningoceles (outpouchings of the meninges filled w/ CSF that push out of the intervertebral foramina)

 

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