Understanding Mediastinal Masses: A Comprehensive Visual Guide

 
Mediastinal Masses
 
Janice Ward
ST6ish
 
RV
 
LV
 
Fat pad
 
Left diaphragm
 
Right diaphragm
Mediastinal compartments
 
4 densities of xray
 
Sihouette Sign
 
An interface is not
visible when two areas
of similar radiodensity
touch.
 
Hilum overaly sign
 
There is aerated lung
infront or behind the
mass making it less
dense than the hilar 
therefore it is not on
the same plane as
the hilar vessels.
 
Note angle 
 not
mediastinal
 
Anterior
 
4Ts
1.
Thymoma
2.
Thyroid
3.
Teratoma
4.
Terrible lymphoma
 
Others
Hernia of Morgagni
Pericardial cyst
Fat pad
Ascending aorta aneurysm
 
Medial
 
Hilar lymph nodes
Bronchogenic cyst
Foregut cyst
Oesophageal tumour
Pericardial/cardiac tumour
Aortic arch or pulmonary artery aneurysm
(Thyroid)
 
Posterior
 
Neural tumours and
cysts
Lipoma
Descending aorta
aneurysm
Gastric pull through
Extramedullary
haematopoesis
Bochdalek posterior
diaphragmatic hernia
 
Management of patient
 
History
?mass effect
E.g. SVCO
?functional effect
E.g myasthenia gravis
Systemic enquiry
metastasis
 
Examination
 
Maybe some reassurance
 
Imaging
Cxr and lateral
CT with contrast
 
CT
 
Anatomy
online
Thymus reduces in size
and disappears by age
40
 
Density
Fluid
Water hounsefield unit 0
Blood 30
Fat
Hounsefield 80
Air
Hounsfield -1000
Bone
Housefield 2000
Enhancement
 
Necrotic lymph nodes
 
Teratoma
 
Next Investigations
 
 
Case
 
Middle age man
Cough
Obs normal
Covid swab
A+E wanted to admit, GIM consultant
discharged with urgent o/p CT and resp
referral
 
Summary
 
Use of logical approach to plain film to localise
mass
List of differentials
Assessment of patient
mass effect or functional effect
CT to characterise
Some further specific tests
 
 
Bibliography
 
https://radiologyassistant.nl/chest/mediastinum-
masses
https://www.radiologycafe.com/medical-
students/radiology-basics/chest-anatomy
BTS short course radiology
Felsons Principles of Chest Roentgenology. Lawrence
Goodman. Second edition. 1999
Thoracic Imaging: Illustrated clinical cases. Copley et al.
second edition. 2014.
Oxford Handbook of respiratory medicine. 
Sophie
West. 
Second edition 2009.
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Explore detailed visuals and descriptions of mediastinal masses, compartments, x-ray densities, and key signs in diagnosis. Learn about different types of masses and their management, including common differential diagnoses and imaging techniques.


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  1. Mediastinal Masses Janice Ward ST6ish

  2. RV LV Left diaphragm Fat pad Right diaphragm

  3. Mediastinal compartments Thoracic duct Heart Trachea oesophagus Nerve roots Lymph nodes Sympathetic and parasympathetic chains Aortic arch Thyroid Thymus Vena cava Ascending aorta Lymph nodes Lymph nodes Descending aorta Pulmonary artery Phrenic Nerve vertebrae

  4. 4 densities of xray

  5. Sihouette Sign An interface is not visible when two areas of similar radiodensity touch.

  6. Hilum overaly sign There is aerated lung infront or behind the mass making it less dense than the hilar therefore it is not on the same plane as the hilar vessels. Note angle not mediastinal

  7. Anterior 4Ts 1. Thymoma 2. Thyroid 3. Teratoma 4. Terrible lymphoma Others Hernia of Morgagni Pericardial cyst Fat pad Ascending aorta aneurysm

  8. Medial Hilar lymph nodes Bronchogenic cyst Foregut cyst Oesophageal tumour Pericardial/cardiac tumour Aortic arch or pulmonary artery aneurysm (Thyroid)

  9. Posterior Neural tumours and cysts Lipoma Descending aorta aneurysm Gastric pull through Extramedullary haematopoesis Bochdalek posterior diaphragmatic hernia

  10. Management of patient History ?mass effect E.g. SVCO ?functional effect E.g myasthenia gravis Systemic enquiry metastasis Maybe some reassurance Imaging Cxr and lateral CT with contrast Examination

  11. CT Anatomy online Thymus reduces in size and disappears by age 40

  12. Density Fluid Water hounsefield unit 0 Blood 30 Fat Hounsefield 80 Air Hounsfield -1000 Bone Housefield 2000 Enhancement Teratoma Necrotic lymph nodes

  13. Next Investigations Possible diagnosis Blood test Specific Imaging Functioning thymoma AChR ab Seminoma US testes Non-seminomatous germ cell tumours bHCG and AFP CT for distant metastasis Thyroid TSH, T4, T3 Radioisotope scan Flow-volume loop Lymphoma FBC, ESR, LDH, HIV PET Surgical biopsy Neural tumours and cysts MRI

  14. Case Middle age man Cough Obs normal Covid swab A+E wanted to admit, GIM consultant discharged with urgent o/p CT and resp referral

  15. Summary Use of logical approach to plain film to localise mass List of differentials Assessment of patient mass effect or functional effect CT to characterise Some further specific tests

  16. Bibliography https://radiologyassistant.nl/chest/mediastinum- masses https://www.radiologycafe.com/medical- students/radiology-basics/chest-anatomy BTS short course radiology Felsons Principles of Chest Roentgenology. Lawrence Goodman. Second edition. 1999 Thoracic Imaging: Illustrated clinical cases. Copley et al. second edition. 2014. Oxford Handbook of respiratory medicine. Sophie West. Second edition 2009.

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