Mediastinal Masses | Loyola Medicine

Mediastinal Masses

Overview and Facts about Mediastinal Masses

The mediastinum is the area of the chest that separates the lungs and contains the heart, aorta, trachea and thymus. It is surrounded by the breastbone, lungs and spine. When a mass or tumor forms in this area, it is either benign (non-cancerous) or malignant (cancerous). These tumors are made from germ cells and develop in either the nerve or soft tissue in this area of the body.

Signs and Symptoms of Mediastinal Masses

In its earlier stages, a mediastinal mass is not usually detectable and causes no symptoms. It is most often found when a patient gets a chest X-ray for an unrelated reason. Symptoms begin when the mass begins pressing on the surrounding areas, causing discomfort and a combination of the following:

  • Chills and fever
  • Cough (and/or coughing up blood)
  • Shortness of breath
  • Pain in the chest
  • Hoarseness of the voice
  • Wheezing
  • Swollen or tender lymph nodes
  • Weight loss without trying
  • Sweating during the night
  • High-pitched, noisy respiration or stridor 

Causes and Risk Factors of Mediastinal Masses

The causes of mediastinal tumors depend on where is the mediastinum they are found, and most often they are benign.

  • Front: caused by lymphoma, thymoma or thyroid mass such as a goiter
  • Middle: caused by bronchogenic or pericardial cysts, goiters, tracheal tumors or aortic aneurysms
  • Back: caused by masses in the bone marrow associated with severe anemia, enlargement of lymph nodes and neurogenic neoplasms

People at a higher risk of developing a mediastinal mass are those aged 30-50. Your age factors in to where the mass develops. Children usually have masses in the back of the mediastinum and they are usually benign. If an adult has this condition, they usually develop in the front and are most often malignant. 

Tests and Diagnosis of Mediastinal Masses

After taking a medical history, assessing symptoms and performing a thorough physical exam, your doctor will order imaging tests to confirm diagnosis of a medistinal mass. These tests include a chest X-ray, CT scan and MRI.

Your doctor may also need a sample of the potentially cancerous tissue. This is the most accurate way to diagnose a mediastinal mass and is called a mediastinoscopy with biopsy. 

Treatment and Care for Mediastinal Masses

Treatment for a mediastinal mass varies according to what kind of tumor it is (thymoma, lymphoma, neurogenic, etc.) and where it is located. Surgery, radiation therapy and chemotherapy are the most common options for treatment.

Surgeries to treat mediastinal masses include:

  • Thoracotomy (an open procedure performed through an incision in the chest)
  • Mediastinoscopy
  • Thoracoscopy: When noninvasive testing or treatment is inconclusive or not an option, you surgeon may recommend a thoracoscopy to evaluate masses or tumors in the thoracic (lung) area. In this procedure, your surgeon makes one or more small incisions between your ribs to see inside your chest. This may be performed as an open procedure or a less invasive alternative called video-assisted thoracic surgery (VATS). In VATS, small tools are passed through small incisions in the chest cavity to perform the surgery.

Prevention and Screening of Mediastinal Masses

There is no method currently known to prevent developing a mediastinal mass. If you have any of the symptoms associated with this condition or other thoracic cancers, talk to your doctor about a screening plan. Non-invasive screening usually involves imaging tests such as chest X-rays, CT scans and/or MRIs