Anterior mediastinal masses generally arise from these structures. We present a unique case of papillary carcinoma of thyroid extending into the posterior mediastinum with superior vena cava syndrome along. Diagnosis is challenging and requires pathological identification and imaging studies. The resulting increased venous pressure in the upper body may cause. Treatment of mediastinal syndrome involves chemotherapy and radiation, radiation alone or surgery according to the etiology. Primary chondroma of posterior mediastinum with horners. Spontaneous rupture of a cystic mediastinal teratoma. Mediastinal masses merck manuals professional edition.
The thoracic plane separates the superior and inferior mediastinum. Contrastenhanced ct scan of the chest revealed a large heterogeneous mass extended from the right superior mediastinum to the right lung base with the encasement of the superior vena cava. Aug 12, 2016 superior vena cava syndrome is the most severe complication of mediastinal syndromes and is considered to be a medical emergency 1,2. Papillary carcinoma of thyroid presenting as posterior. Approximately 10% of tumours that occur in the anterior superior mediastinum compress the superior vena cava svc andor the proximal tracheal airway or main bronchus. The radiographic features included a smooth bilateral widening of the superior mediastinum, relative lucency, no definable mass in the lateral view, and no pressure effects on the trachea.
We present the case of a nonfunctional superior mediastinal paraganglioma in a patient with. Hence, the two terms are often used interchangeably in children. Due to their location, they produce characteristic clinical picture, totally referred to as the mediastinal syndrome. Mediastinal neuroendocrine carcinoma of unknown origin. Myelodysplasia presenting as granulocytic sarcoma of mediastinum causing superior vena cava syndrome. The inferior mediastinum is further subdivided into the middle mediastinum, which consists of the pericardium and heart, the anterior mediastinum, which is a space.
Most superior vena cava svc syndromes are caused by malignancies eg, lymphoma and lung cancer. The superior mediastinal mass present above the thoracic plane upper side. Mediastinal fibrosis and superior vena cava syndrome. Separation between superior and inferior mediastinum 2. It is a plane at the level of the sternal angle, and the intervertebral disc of t4t5. The majority of cases are caused by malignant tumors within the mediastinum, most commonly lung cancer and nonhodgkins lymphoma, directly compressing or invading. The inferior mediastinum is further divided into the anterior, middle and posterior mediastinum. Here we report an unusual case of a cystic teratoma, which ruptured into the mediastinal and pleural cavities resulting in superior vena cava syndrome, acute mediastinitis, and pleural effusion.
The mediastinum is an area found in the midline of the thoracic cavity, that is surrounded by the left and right pleural sacs. In infants and younger children, air within the mediastinum may displace the thymus superiorly to produce the spinnaker sail sign see fig. The posterior mediastinum is the portion of the mediastinum located posteriorly to the pericardium and anteriorly to the t5t12 vertebrae, inferior to the transverse thoracic plane. Review of evolving etiologies, implications and treatment. Pdf mediastinal tuberculous lymphadenitis presenting as. In cases where the tumor is malignant the prognosis is guarded and care should be taken to prevent the tumor from invading other organs of the body and complicating things as a result of mediastinal tumors, although with appropriate. Included within the mediastinum are numerous structures, ranging from the heart and great vessels aorta, superior and inferior venae cavae to lymph nodes and nerves.
Early diagnosis and prompt surgical treatment of ruptured mediastinal. Superior vena cava svc syndrome refers to the clinical manifestation due to an obstruction in the svc. An increase in the incidence of this syndrome has been observed following the widespread use of diagnostic imaging. Apr 30, 2020 the mediastinum is an area found in the midline of the thoracic cavity, that is surrounded by the left and right pleural sacs. In addition, pulmonary cancer is the most common cause of mediastinal syndrome. It may decompress into the superior mediastinum and dissect along fascial planes into the subcutaneous tissues of the neck and retropharynx efig. Spaceoccupying lesions in the medistinum are not uncommon. Superior mediastinum is an artificially divided wedgeshaped compartment of the mediastinum located between the thoracic plane inferiorly and the thoracic inlet superiorly. Primary mediastinal chondroma is rare, especially with horners syndrome. Oct 10, 2012 superior vena cava syndrome svcs refers to signs and symptoms caused by obstruction of the superior vena cava. The superior vena cava syndrome svcs comprises various symptoms due to occlusion of the svc, which can be easily obstructed by pathological conditions eg, lung cancer, due to the low internal venous pressure within rigid structures of the thorax trachea, right bronchus, aorta. Images in superior vena cava syndrome due to mediastinal. After complete dissection of the mass, a pathological diagnosis of the primary. The clinical diagnosis of svc syndrome is based largely on history and physical examination.
Superior vena cava syndrome obstruction of blood flow through the superior vena cava causes dilation of the collateral veins of the upper thorax and neck and edema and congestion of the face patients may have headache, dyspnea, dysphagia, and wheezes. Superior vena cava svc syndrome due to direct invasion from a primary thyroid malignancy is a rare phenomenon. Disorders of the pleura, mediastinum, and chest wall andrew barnosky, do, mph. An imaginary plane at the lower border of the manubrium sterni divides the mediastinum into superior mediastinum above and anterior, middle, and posterior mediastinum below. Svcs, or superior vena cava syndrome can result from either partial or complete obstruction to blood flow via the svc to the right atrium by extrinsic compression or invasion. The inferior mediastinum, comprising of the anterior, middle and posterior parts, lies inferiorly. Symposium on pgimer management protocols on oncological emergencies superior mediastinal syndrome.
It is divided into the superior and inferior mediastinum, of which the latter is larger the inferior mediastinum is further divided into the anterior, middle and posterior mediastinum. May 29, 2019 mediastinitis is an infection involving the mediastinum. Chest xray may detect the mass but does not evaluate compression or internal thrombosis of the superior vena cava, which is best assessed with ct with iv contrast. Mediastinal mass anterior, posterior, superior, symptoms.
Chondroma is a slowly growing, benign cartilaginous tumor which predominantly occurs in long bones of the hands and feet. N 191, 198, 231, tg 418, 435, 435, 436, 436 superior mediastinum. Evidence of mediastinal fibrosis as a cause of superior vena cavai syndrome has consequences in treatment, for radiotherapy is then contraindicated as it stimulates fibrosis 2, 17. I guess i better reply right away it sounds important. In children, a mediastinal pathology causing svcs generally results in sms as well, due to the limited chest volume. Apr 24, 2020 the demarcation between the posterior and superior mediastinum is somewhat arbitrary, but widely agreed. Superior vena cava svc syndrome is the result of stenosis or occlusion of the svc or bilateral brachiocephalic veins. Underestimated awakening faceedema caused by a mediastinal. Spontaneous rupture of cystic mediastinal teratomas is rare but may cause serious complications. Superior vena cava syndrome etiology bmj best practice. Locate the plane of the sternal angle and note what lies cranial and caudal to it. Superior mediastinum definition of superior mediastinum by.
The normal contents of the anterior mediastinum include the thymus, lymph nodes, adipose tissue, nerves, vessels, and sometimes downward extension of the thyroid from the neck. Superior mediastinal syndrome sms is the term used when svcs coexists with obstruction of trachea. The resulting increased venous pressure in the upper body may cause edema of the head, neck, and upper. Role of irradiation in the management of superior vena cava syndrome. Here, we present a case of superior vena cava svc syndrome secondary to. Emergency management article pdf available in the indian journal of pediatrics 801 october 2012 with 4,040 reads how we measure reads. Enlarged thyroid with retrosternal extension presenting as anterior mediastinal mass is known. Its superior and inferior borders are the thoracic inlet and the diaphragm, respectively. Interest in the mediastinum as a separate body region stems from the diversity and importance of the structures it contains and the multiplicity of disease processes by which it can be affected.
Then we will start from the anterior boundary and work our way through the superior mediastinum from anterior to posterior. Disorders of the pleura, mediastinum, and chest wall. Superior vena cava syndrome in thoracic malignancies. Larger thymic cysts may present as dumbbellshaped cervicothoracic masses, with the mass traversing the thoracic inlet from the lower lateral neck into the superior mediastinum figs.
Superior vena cava syndrome is the most severe complication of mediastinal syndromes and is considered to be a medical emergency 1,2. The latter is the enlarged, quadrangular shaped bone of the uppermost sternum. Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2011. Lesions in the middle mediastinum may compress blood vessels or airways, causing the superior vena cava syndrome or airway obstruction. A rare presenting feature of acute myeloid leukemia superior mediastinal syndrome sms is an uncommon manifestation of malignant neoplastic disease. Extracapsular bleeding can cause a rare extensive cervical hematoma. Appropriate imaging techniques are important to con. Superior vena cava syndrome due to mediastinal gardner. The mediastinum is a large anatomic compartment in the thoracic cavity, bounded laterally by the pleurae, anteriorly by the sternum, posteriorly by the vertebrae, superiorly by the thoracic inlet, and inferiorly by the diaphragm. Medical management of the thoracic surgery patient, 2010. Superior caval vein syndrome is the most severe complication of mediastinal syndromes and is considered a medical emergency. This article will consider the borders and contents of this anatomical compartment.
It is a surgical emergency with a high mortality rate. Superior vena cava syndrome svcs, is a group of symptoms caused by obstruction of the superior vena cava svc, a short, wide vessel carrying circulating blood into the heart. Superior vena cava syndrome svcs refers to signs and symptoms caused by obstruction of the superior vena cava. The inferior mediastinal mass present below the thoracic plane lower side. It is a relatively common complication of lung cancer, and may constitute one of the early manifestations of this disease. Sep 08, 2015 this video tutorial covers the basic regional anatomy of what the mediastinum is with a focus on the posterior and superior mediastinum. Myelodysplasia presenting as granulocytic sarcoma of. It is epidemiology, clinically and biologically distinct from the other subtypes of dlbcl. Superior vena cava syndrome in children is a rare medical problem but when it is. Mediastinum, pericardium, heart flashcards quizlet.
The heart starts at the level of t45 vertebral disc at the transthoracic plane. Primary mediastinal small cell neuroendocrine carcinoma. A mediastinal small cell neuroendocrine carcinoma mscnc is a rare form of neuroendocrine malignancy. The squeezing of the windpipe is referred to as superior mediastinal syndrome. Mediastinal masses and adenopathy may widen the mediastinum on the frontal projection figures 5176 through 5178. Nathan kim3 abstract superior vena cava syndrome svcs is a relatively common sequela of mediastinal malignancies and may cause. The inferior mediastinum from this level to the diaphragm. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome christopher straka1, james ying 1, feng. The mediastinum is the region of the thoracic cavity located between the two lungs. There are no physical structures that divide the superior and inferior mediastina therefore pathological processes can freely. Mediastinal tuberculous lymphadenitis presenting as superior. Respiratory system disordersdiseases of the mediastinum. Paragangliomas in the mediastinum, especially the superior mediastinum, are extremely rare.
Mediastinal masses can result in superior vena cava syndrome see figures 5179 through 5182. These tumors are aggressive and recurrence and metastases frequently complicate patient management. Here, we present a case of superior vena cava svc syndrome secondary to circumferential compression by a. Mar 29, 2014 extraadrenal pheochromocytomas are termed paragangliomas. It is further subdivided into four arbitrary portions by the pericardium, namely, superior, anterior, middle, and posterior compartments. Divided in superior and inferior divisions by imaginary line passing from the sternal angle anteriorly to the lower border of the 4th thoracic vertebrae. The prognosis of mediastinal tumors depends on the location of the tumors and whether they are benign or malignant. Cureus primary mediastinal small cell neuroendocrine. It is divided into the superior and inferior mediastinum, of which the latter is larger. Lung cancer is the most common etiology, nonsmall cell lung cancer accounting for 50% of cases of malignant svc syndrome and small cell lung cancer for 25% cases. Extraadrenal pheochromocytomas are termed paragangliomas. Carefully peel away the mediastinal pleura from the.
The superior mediastinum starts at the superior thoracic aperture and ends at the thoracic plane. The mediastinum is the region in the chest between the pleural cavities that contains the heart and other thoracic viscera, except the lungs. Chest xray showed a new soft tissue density in the right paratracheal region and subsequent computerized tomography ct scan of the chest revealed a 6. The majority of cases are caused by malignant tumors within the mediastinum, most commonly lung cancer and nonhodgkins lymphoma, directly compressing or invading the svc wall. This division is a horizontal plane traversing the bottom edge of the t4, or fourth upper thoracic vertebra, with the bottom edge of the manubrium sterni. With the thorax in tact, the first thing you see when you get ready to study the superior mediastinum is the manubrium of the sternum and the cartilage. Oct 17, 2018 chondroma is a slowly growing, benign cartilaginous tumor which predominantly occurs in long bones of the hands and feet. Superior vena cava syndrome svcs is a disease entity with notable signs and symptoms that cannot go unnoticed by clinicians.
Overview the contents of the superior mediastinum are composed of structures that are continuous with the neck superiorly and the inferior mediastinum which is further subdivided into the anterior, posterior and middle mediastinum inferiorly. The obstruction can occur either due to tumour invasion of the vessel wall with associated thrombus or due to vessel wall compression by the tumour mass. The main purpose of this paper is to call attention to this etiologic factor and also to the value of radiological examination with mediastinal phlebography 79. Idiopathic fibrosis of the mediastinum as a cause of superior. Mediastinitis may begin primarily from structures in the mediastinum often as a result of iatrogenic injury or may result from an infection extending downward from the oropharynx, in which case it is called descending necrotizing mediastinitis dnm. Large anterior mediastinal masses may cause dyspnea when patients are lying supine. Mediastinal tuberculous lymphadenitis presenting as superior vena cava syndrome article pdf available in the journal of thoracic and cardiovascular surgery 16. Ganglioneuroblastoma is a rare peripheral neuroblastic tumor that is derived from developing neuronal cells of the sympathetic nervous system, and is found mostly, but not exclusively, in babies and young children. Define the boundaries of the superior mediastinum and peel away the mediastinal pleura. A case of superior mediastinal widening due to unusual amounts of fat accumulation is reported in a patient with simple obesity, not associated with iatrogenic or primary cushings syndrome.
Idiopathic fibrosis of the mediastinum as a cause of. This image shows the structures of the superior mediastinum in tact. The inferior mediastinum is the boxshaped space in the mediastinum below the transthoracic plane of ludwig between the wedgeshaped superior mediastinum above and the diaphragm and inferior thoracic aperture below. We reported the case of a 31yearold woman with a posterior mediastinum mass associated with horners syndrome. Lesions in the posterior mediastinum may encroach on the esophagus, causing dysphagia or odynophagia. The posterior mediastinum borders contents teachmeanatomy. To the best of our knowledge, there have been no previously reported cases of ganglioneuroblastoma of the mediastinum from pakistan. On the lateral projection, the retrosternal space may be opacified, indicating a mass lesion see box 53 figures 5179 through 5182. The patient being reported is a young male who presented. The inferior segment is further divided into three divisions and mass can shape any of these three divisions, which comprise the central segment which. In the present study, three different cases of mediastinal syndrome, one of which was complicated by superior vena cava syndrome, are discussed. Since this is the plane that separates superior mediastinum from inferior mediastinum heart is in middle, inferior mediastinum and trachea is in superior mediastinum.
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