Multimodality imaging of mediastinal masses and mimics.

A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their mimics. Localization of a mediastinal lesion to a compartment and characterization of morphology, density/signal intensity, enhancement, and mass effect on neighboring structures can help narrow the differentials. The International Thymic Malignancy Interest Group (ITMIG) established a cross-sectional imaging-derived and anatomy-based classification system for mediastinal compartments, comprising the prevascular (anterior), visceral (middle), and paravertebral (posterior) compartments. Cross-sectional imaging is integral in the evaluation of mediastinal lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to characterize mediastinal lesions detected on radiography. Advantages of CT include its widespread availability, fast acquisition time, relatively low cost, and ability to detect calcium. Advantages of MRI include the lack of radiation exposure, superior soft tissue contrast resolution to detect invasion of the mass across tissue planes, including the chest wall and diaphragm, involvement of neurovascular structures, and the potential for dynamic sequences during free-breathing or cinematic cardiac gating to assess motion of the mass relative to adjacent structures. MRI is superior to CT in the differentiation of cystic from solid lesions and in the detection of fat to differentiate thymic hyperplasia from thymic malignancy.

Clinico-Pathological and Radiological Spectrum of Mediastinal Masses in a Tertiary Care Center: A Cross-Sectional Study.

Introduction The phrase "mediastinal mass" refers to a mass within the mediastinum. About 50% of all mediastinal masses, including teratoma, thymoma, lymphoma, and thyroid illness, are anterior mediastinal tumors. Data on the mediastinal mass in India are relatively sparse, especially in this region, compared to those from other countries. Mediastinal masses are very infrequent lesions that might occasionally present a diagnostic and therapeutic challenge to the doctor. The current study describes the socio-demographic characteristics, symptoms, diagnosis, and location of mediastinal mass among the study participants. Methodology We carried out a retrospective, cross-sectional study in a tertiary care center in Chennai for three years. We included patients with an age above 16 years who visited the tertiary care center in Chennai during the study period. We included all patients with a mediastinal mass diagnosed by CT scan, with or without signs and symptoms of mediastinal compression. Patients under the age of 16 and those with insufficient data were both excluded from the study. As per the universal sampling technique, we included all the patients who met the eligibility criteria during the study period (three years) as study subjects. By using the hospital records, we collected all data about the patients like socio-demographic data, presenting complaints, past history, x-ray findings, and co-morbidities. Similarly, we recorded blood parameters, pleural fluid parameters, and histopathological reports from the laboratory register. Results The mean age of the study participants was 41.11 years, with a high proportion of patients belonging to the age group of 21 to 30 years. Over 70% of the study participants were male. Only about 54.5% of the study participants had symptoms because of a mediastinal mass. The most common local symptom felt by the patients was dyspnea, followed by a dry cough. Weight loss was the most common symptom for the patients. Most study participants (47.7%) had seen a doctor within one month of the onset of symptoms. About 4.5% of the patients had pleural effusion, as diagnosed by x-ray. Most of the study participants had a mass in the anterior mediastinum, followed by the posterior mediastinum. Most of the participants (15.9%) had non-caseating granulomatous inflammation suggestive of sarcoidosis.  Conclusion The most common tumor found in our study was lymphoma, which was followed by non-caseating granulomatous disease and thymoma. Anterior compartments are most commonly involved. We observed the most common presentation in the third decade of life with a male to female ratio of 2:1, with dyspnea being the most common symptom, followed by a dry cough. Our study found 4.5% of the patients had pleural effusion as a complication.

Caracterización de los pacientes operados de tumores del mediastino / Surgical-evolutionary Characterization of Patients Operated on for Mediastinal Tumors

RESUMEN Introducción: Las neoplasias mediastinales son tumores poco frecuentes, pueden aparecer a cualquier edad, por lo general entre la tercera y quinta décadas y se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Objetivo: Caracterizar a los pacientes operados de tumores de mediastino según variables clínicas y quirúrgicas. Métodos: Se realizó un estudio observacional, descriptivo, de tipo serie de casos con una muestra de 37 pacientes ingresados y operados en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, con diagnóstico de tumor mediastinal durante los años 2010 a 2017. Resultados: La esternotomía fue la vía de acceso más utilizada y se logró efectuar exéresis completa en 31 enfermos. Primaron las variedades histológicas malignas (54,1 por ciento); solo hubo cuatro complicaciones posoperatorias de relevancia y dos fallecidos. Conclusión: Predominaron los tumores malignos en los que se identificó una amplia gama de variedades histológicas, atribuibles a las características del órgano afectado. La selección de la vía de entrada al tórax, así como el procedimiento quirúrgico estuvo condicionados por el lugar y tamaño del tumor en el mediastino. Los resultados quirúrgicos fueron favorables, avalados por el bajo número de complicaciones y nivel de mortalidad en la serie(AU)

ABSTRACT Introduction: Mediastinal neoplasms are rare tumors that may appear at any age, generally between the third and fifth decades of life, and incidentally discovered by a routine chest radiograph performed on asymptomatic patients. Objective: To characterize the patients operated on for mediastinal tumors according to selected surgical and evolutionary variables. Methods: An observational, descriptive and case series study was carried out with a sample of 37 patients hospitalized and operated on in the general surgery service at Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, with a diagnosis of mediastinal tumor, and during the years 2010 to 2017. Results: Sternotomy was the most widely used access route and complete exeresis was achieved in 31 patients. Malignant histological varieties prevailed (54.1 percent). There were only four relevant postoperative complications and two deaths. Conclusion: Malignant tumors predominated with a wide range of histological varieties identified, attributable to the characteristics of the affected organ. Selection of the access route into the thorax and the surgical procedure were conditioned by location and size of the tumor in the mediastine. The surgical outcomes were favorable, supported by the low number of complications and the level of mortality in the series(AU)

Caracterización de pacientes operados por tumores del mediastino / Characterization of operated patients because of mediastinal tumors

Introducción: Las neoplasias mediastinales son tumores poco frecuentes, pueden aparecer a cualquier edad y por lo general se descubren incidentalmente en una radiografía de tórax de rutina en pacientes asintomáticos. Objetivo: Caracterizar a los pacientes operados por tumores de mediastino según variables clínico- epidemiológicas y diagnósticas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo, de tipo serie de casos con 37 enfermos ingresados y operados con diagnóstico de tumor mediastinal, en el Servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante los años 2010 a 2017. Resultados: Predominó el sexo femenino con 23 pacientes y el intervalo de edad entre 31 y 40 años (11 casos). Los síntomas más comunes fueron dolor torácico, tos y disnea. El compartimiento posterior fue el mayormente afectado (11 pacientes), así como los tumores con tamaños entre 7 y 9 cm (17 enfermos). Los medios diagnósticos más utilizados fueron la tomografía computarizada, la broncoscopia y la mediastinoscopia. Primaron los tumores malignos (54,1 por ciento) en los que se identificó una amplia gama de variedades histológicas. Conclusiones: El diagnóstico definitivo generalmente se establece mediante el estudio histopatológico posquirúrgico, aunque la tomografía computarizada asociada o no a la biopsia percutánea es la regla de oro para el diagnóstico preoperatorio. Las variedades histológicas de los tumores malignos son atribuibles a las características del órgano afectado(AU)

ABSTRACT Introduction: Mediastinal neoplasms are rare tumours; they can appear at any age and they are usually discovered incidentally on a routine chest radiograph in asymptomatic patients. Objective: To characterize patients operated on mediastinal tumours according to selected clinical, epidemiological and diagnostic variables. Methods: An observational, descriptive study of a series of cases with 37 patients admitted and operated with diagnosis of mediastinal tumour in the General Surgery Service of the Provincial Teaching "Saturnino Lora" Hospital from Santiago de Cuba, during the years 2010 to 2017. Results: The female sex predominated with 23 patients and the age interval between 31 and 40 years (11 cases). The most common symptoms were chest pain, cough and dyspnea. The posterior compartment was the most affected (11 patients), as well as the tumors with sizes between 7 and 9 cm (17 cases). The most used diagnostic means were computed tomography, bronchoscopy and mediastinoscopy. Malignant histological varieties prevailed (54.1 percent). Conclusions: The definitive diagnosis is usually established by postoperative histopathological study, although computed tomography associated or not with percutaneous biopsy is the gold standard for preoperative diagnosis. Malignant histological varieties are related with characteristics of the affected organ(AU)