Paediatric mediastinal masses

Changed by Daniel J Bell, 28 Jan 2021

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Paediatric mediastinal masses are the most common chest masses in children, with the anterior mediastinum being the most common site ¹.

As in adults, mediastinal masses are classified depending on anatomical sites:

anterior mediastinal masses
middle mediastinal masses
posterior mediastinal masses

Anterior mediastinal masses

Basic approach to these lesions is by chest radiograph (PA and lateral) for localisation followed by contrast-enhanced CT for characterisation:

malignant lymphoma (Hodgkin and non-Hodgkin) - most common
teratoma - common
thymus (benign enlargement) - common
thyroid (retro- or ~~sub-sternal~~substernal extension)
thymic cyst
angioma
~~langerhans~~Langerhans cell histiocytosis
mesenchymal tumors
lymphangioma (cystic hygroma) - generally extends from neck into mediastinum

Middle mediastinal masses

Basic approach to these lesions is by chest radiograph (PA and lateral) for localisation, with barium swallow to identify areas of compression followed by contrast-enhanced CT for characterisation:

foregut duplication cyst (bronchogenic, enteric, and neuroenteric) - most common; bronchogenic cyst is more common
lymphadenopathy
vascular malformations

Posterior mediastinal masses

Basic approach to these lesions is by chest radiograph (PA and lateral) for localisation followed by MRI for evaluation of intraspinal extension of neurogenic tumors and distinction between vascular structures and soft tissues. Contrast-enhanced CT can be carried out when MRI is not available:

~~-<a href="/articles/thyroid-gland">thyroid</a> (retro- or sub-sternal extension)</li>~~
+<a href="/articles/thyroid-gland">thyroid</a> (retro- or substernal extension)</li>
~~-<li><a href="/articles/langerhans-cell-histiocytosis">langerhans cell histiocytosis</a></li>~~
+<li><a href="/articles/langerhans-cell-histiocytosis">Langerhans cell histiocytosis</a></li>

Updates to Synonym Attributes

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