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Mediastinal Masses

by Richard W. Light, MD

Mediastinal masses include tumors, fluid-filled sacs (cysts), and other abnormalities in the organs of the mediastinum. These organs include the heart, the thymus gland, some lymph nodes, and parts of the esophagus, aorta, thyroid, and parathyroid glands.

  • These masses may cause no symptoms, but they may cause chest pain, weight loss, fever, difficulty swallowing, cough, or difficulty breathing, particularly in children.

  • Chest x-rays, computed tomography (CT), and biopsy are needed for diagnosis.

  • Treatment depends on the cause of the mass.

Doctors classify masses according to which part of the mediastinum they develop in: the front (anterior), middle, or back (posterior—see Overview of Pleural and Mediastinal Disorders). The area in which the mass develops may provide a clue to the cause.

Mediastinal masses may be

  • Cancerous

  • Noncancerous

Noncancerous masses include cysts in the heart and pouch-like sacs or bulges that develop in the wall of an organ, such as the esophagus (called a diverticula) or the aorta (called an aneurysm). Organs may enlarge, as occurs when a goiter forms in the thyroid gland or when cancer (lymphoma) or an infection causes the lymph nodes to enlarge. Children may have birth defects in the mediastinum (for example, cysts, blood vessel abnormalities, or abnormal development of the esophagus).

Symptoms

Masses in the mediastinum occasionally cause no symptoms, especially small masses in adults. Masses, including cancers, are more likely to cause symptoms in children.

The most common symptoms in adults and children are chest pain and weight loss. Some masses cause fever. Others cause difficulty swallowing. In children, mediastinal masses are more likely to cause cough or shortness of breath due to airway compression..

Diagnosis

  • Chest x-ray

Masses in the mediastinum are often discovered when a chest x-ray is taken or another imaging test is done to evaluate symptoms such as chest pain, cough, or difficulty breathing or is done for another reason. Additional tests, usually CT and biopsy, are needed to determine the cause of the mass.

Treatment

  • Treatment depends on the cause

Treatment depends on the cause. If the mass is not cancer and is causing no symptoms, doctors may monitor the person regularly instead of treating the mass. Cancers may be removed surgically or treated with chemotherapy. An infection that causes swollen lymph nodes is usually treated with antibiotics or antifungal drugs.