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Pediatric Mediastinal Tumors



Mediastinum
  • Region between the pleural sacs

Has 3 compartments
  • anterior
  • middle
  • posterior
Contents of the Anterior Mediastinum
  • Thymus
  • Anterior mediastinal lymph nodes
  • Internal mammary A & V
  • Pericardial fat
Contents of the Middle Mediastinum
  • Heart & Pericardium, ascending aorta & arch of aorta, vena cavae, brachiocephalic A &V ,
  • phrenic nerve
  • trachea, main  stem bronchi & contiguous lymph nodes
  • Pulmonary A & V 
Contents of the Posterior Mediastinum
  • Descending thoracic aorta
  • Esophagus
  • Thoracic duct
  • Azygos & hemiazygos vein
  • Posterior group of mediastinal nodes
  • Sympathetic trunk & intercostal nerves

Boundaries of the mediastinum
  • Anterior - sternum
  • Posterior - Vertebral Column
  • Superior - Thoracic inlet
  • Inferior - Diaphragm
** Mediastinum is connected to neck & retroperitoneum allowing spread of air & infection

Masses in the Anterior Mediastinum (4 T's) (30% of mediastinal masses)
  • Thymoma
  • Teratoma
  • Thyromegaly
  • Terrible Lymphoma
  • Lipoma, Fibroma - rare
Masses in the Middle Mediastinum (30% of mediastinal masses)
  • Aneurysms - aorta, innominate artery, enlarged pulmonary artery
  • Lymphadenopathy secondary to carcinoma / metastasis / granulomatosis
  • Cysts - enteric, bronchogenic, pleuropericardial
  • Dilated azygos, hemiazygos veins
  • Hernia of  Foramen of Morgagni
Masses in the Posterior Mediastinum (40% of mediastinal masses)
  • Neurogenic tumors
  • Meningo-myelocele, meningocele
  • Esophageal - tumor, cyst, diverticula
  • Hiatus hernia
  • Hernia of  Foramen of Bochdalek
  • Thoracic spine disease,
  • Extramedullary hematopoiesis
Pediatric Presentation
  • 33% of all masses present in patients less than 15 years old
  • If small, usually asymptomatic and found incidentally (cautious work up)
    If large, usually present with respiratory distress (frantic work up)
Differential Diagnosis
Lymphoma
  • Most common pediatric mediastinal malignancy
  • may be found in any compartment of the mediastinum
Neurogenic
  • Ganglioma, ganglioneuroblastoma, neuroblastoma, paraganglioma
  • Most common benign lesions
  • 2nd most common malignant lesions
  • Most often in posterior mediastinum
Teratoma
  • common found in the anterior mediastinum
  • with malignancy potential




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