Anterior mediastinal mass - NYSORA

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Anterior mediastinal mass

Anterior mediastinal mass

Learning objectives

  • Describe the common causes and symptoms of anterior mediastinal masses
  • Manage patients with anterior mediastinal masses

Definition 

  • Mediastinal masses constitute a heterogeneous group of benign and malignant tumors
  • Most common masses in the anterior mediastinum:
    • Thymoma
    • Teratoma
    • Thyroid goiter
    • Lymphoma
    • Germ cell tumor
    • Thymic cyst
    • Parathyroid adenoma

Signs & symptoms

Anterior mediastinal masses can manifest as systemic syndromes (e.g., myasthenia gravis and thyroid disease) or symptoms stemming from localized pathology

PathologySymptoms
Tracheobronchial obstructionDyspnea
Noisy breathing
Nonspecific cough
Chest discomfort
Tachypnea
Stridor
Rhonchi
Decreased breath sounds
Superior vena cava syndrome
Dyspnea
Headache
Visual disturbance
Altered mentation
Dilated collateral veins in the upper body
Edema of the face, neck, and arms
Right heart and pulmonary vascular compression
Dyspnea
Syncope during a forced Valsalva maneuver
Arrhythmias
Cardiac murmur

Management

anterior mediastinal mass, chest x-ray, ct, echo, orthopnea, cough, supine, stridor, syncope, edema, tracheal cross-sectional area, carinal, bronchial compression, pericardial effusion, local, regional anesthesia, general anesthesia, cardiopulmonary bypass, fiberoptic intubation, ventilation, muscle relaxant, rigid bronchoscopy, fio2, cpap, ipvv, peep, olv, sternotomy, extubate, emergency

Suggested reading

  • Almeida PT, Heller D. Anterior Mediastinal Mass. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546608/
  • McLeod M, Dobbie M. Anterior mediastinal masses in children. BJA Education. 2019;19(1):21-6.
  • Ku, Chih Min. “Anesthesia for patients with mediastinal masses.” Principles and Practice of Anesthesia for Thoracic Surgery. Springer New York, 2011. 201-210.

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