Mediastinal Masses

The mediastinum is the central part of the chest (thoracic) cavity. It contains the heart and its major blood vessels, esophagus, thymus, trachea, lymph nodes and major nerves.

Different types of masses, both benign (non-spreading or invading) and cancerous (able to spread or invade), develop in the mediastinum. Because of their location in this critical area, even benign masses can cause serious issues. The type of problem a tumor or mass may cause depends on its specific location within the mediastinum

Causes

There are several types of mediastinal masses; the cause is linked to where they form in the mediastinum. 


  • Anterior (front) mediastinum are masses that form in the front part of the central chest area.
    • Thymus tumors: less aggressive cancers such as thymoma or, less commonly, very aggressive such as thymic carcinoma
    • Lymphoma: a cancer of lymph glands
    • Thyroid tumors: typically benign tumors that grow down into the chest from the thyroid gland
    • Teratomas: typically benign abnormal masses of normal tissue
  • Middle mediastinum are masses that form in the middle of the central chest area. Masses in this area can apply pressure on the heart and its vessels, causing chest pain.
    • Various cysts: typically benign growths
    • Thyroid masses: such as a goiter
    • Tracheal tumors: benign or cancerous masses on the trachea
  • Posterior (back) mediastinum are masses that form in the back of the central chest area. Tumors or masses in this area can apply pressure on the spine.
    • Neurogenic tumors: typically benign tumors that grow from nerve tissues

Symptoms

  • Chest pain
  • Persistent cough
  • Shortness of breath or wheezing
  • Fever or night sweats
  • Difficulty swallowing
  • Hoarseness
  • Unexplained weight loss
  • Swelling of the face and upper extremities, particularly when in the supine position (lying face up)

Diagnosing Mediastinal Masses

Many people who have mediastinal tumors or other masses experience no symptoms. Masses are often discovered on a chest X-ray or CT scan performed for another reason. Masses also may be diagnosed using a scope to look inside the chest cavity and taking a tissue biopsy.

Treatments

Treatment depends on the location and cause of a mass. Typically, masses are treated with appropriate drugs and/or are surgically removed.

  • Sternotomy: The surgeon makes a large incision in the center of the chest and separates the breastbone to gain access to the mediastinum.
  • Thoracotomy: The surgeon makes an incision on the side, back or between the ribs to gain access to the chest cavity between the ribs.
  • Video-assisted thoracic surgery (VATS): Tiny incisions are made in the chest, and a fiber-optic camera and tiny surgical instruments are inserted.
  • Robotic-assisted removal: Like VATS, tiny incisions are made in the chest, but robotic tools provide much better flexibility and dramatically improved visuals.