Paediatric mediastinal masses

Last revised by Andrew Kirby on 6 Nov 2023

Citation, DOI, disclosures and article data

Citation:

Shetty A, Kirby A, Bell D, et al. Paediatric mediastinal masses. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://radiopaedia.org/articles/27401

DOI:

Permalink:

https://radiopaedia.org/articles/27401

rID:

27401

Article created:

2 Feb 2014, Aditya Shetty

Disclosures:

At the time the article was created Aditya Shetty had no recorded disclosures.

View Aditya Shetty's current disclosures

Last revised:

6 Nov 2023, Andrew Kirby

Disclosures:

At the time the article was last revised Andrew Kirby had no financial relationships to ineligible companies to disclose.

View Andrew Kirby's current disclosures

Revisions:

8 times, by 7 contributors - see full revision history and disclosures

Systems:

Chest, Paediatrics

Sections:

Classifications

Tags:

shetty

Synonyms:

Pediatric mediastinal masses

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 substernal extension)
thymic cyst
angioma
Langerhans cell histiocytosis
mesenchymal tumours
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 tumours and distinction between vascular structures and soft tissues. Contrast-enhanced CT can be carried out when MRI is not available:

References

1. Ranganath SH, Lee EY, Restrepo R et-al. Mediastinal masses in children. AJR Am J Roentgenol. 2012;198 (3): W197-216. doi:10.2214/AJR.11.7027 - Pubmed citation
2. King R, King TR, King SW, King BP, King HM, King. Primary Mediastinal Tumors in Children. (1982) Journal of pediatric surgery. doi:10.1016/s0022-3468(82)80100-0 - Pubmed
3. Hope JW, Barns PF, Koop CE. Radiologic Diagnosis of Mediastinal Masses in Infants and Children. (1963) Radiologic clinics of North America. doi: - Pubmed
4. Siegel MJ, Nadel SN, Glazer HS, Sagel SS. Mediastinal Lesions in Children: Comparison of CT and MR. (1986) Radiology. doi:10.1148/radiology.160.1.3715038 - Pubmed
5. Bisset G III. Pediatric Thoracic Applications of Magnetic Resonance Imaging. (1989) Journal of thoracic imaging. doi:10.1097/00005382-198904000-00009 - Pubmed
6. Castellino RA. Diagnostic imaging evaluation of Hodgkin’s disease and non-Hodgkin’s lymphoma. (1991) Cancer. doi:10.1002/1097-0142(19910215)67:4 - Pubmed
7. Helund GL, Bisset GS Ill. Esophageal Duplication Cyst and Aberrant Right Subclavian Artery Mimicking a Symptomatic Vascular Ring. (1989) Pediatric radiology. doi:10.1007/BF02389569 - Pubmed
8. Hemandez RJ. Role of CT in the Evaluation of Children With Foregut Cyst. (1987) Pediatric radiology. doi:10.1007/BF02388234 - Pubmed
9. Siegel MJ, Glazer HS, Wiener JI, Molina PL. Normal and Abnormal Thymus in Childhood: MR Imaging. (1989) Radiology. doi:10.1148/radiology.172.2.2748817 - Pubmed
10. Siegel MJ, Jamroz GA, Glazer HS, Abramson CL. MR imaging of intraspinal extension of neuroblastoma.(1986) J Comput Assist Tomogr. doi:10.1097/00004728-198607000-00008 - Pubmed

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