Differential for an anterosuperior mediastinal mass
An anterosuperior mediastinal mass can be caused by neoplastic and non-neoplastic pathology. As their name suggests, they are confined to the anterior mediastinum - that portion of the mediastinum anterior to the pericardium and below the level of the clavicles.
The differential diagnosis for an anterior mediastinal mass includes:
-
thymus
- thymoma : most common primary neoplasm of the anterosuperior mediastinum
- invasive thymoma
- thymic carcinoma
- thymolipoma / thymoliposarcoma
- thymic cyst
- benign thymic hyperplasia
- thymic carcinoid
- thyroid and parathyroid
- lymphoma
-
germ cell tumours
-
mediastinal teratoma
- mature : 75% of mediastinal germ cell tumours
- immature
- teratocarcinoma (malignant teratoma)
- mediastinal seminoma
- mediastinal embryonal cell carcinoma
- mediastinal yolk sac tumour
- mediastinal choriocarcinoma
- mediastinal mixed cell type germ cell tumour
-
mediastinal teratoma
- thoracic aortic aneurysm
A helpful mnemonic is the 5 T's.

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