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Approach to the adult patient with a mediastinal mass

Mark F Berry, MD
Section Editors
Nestor L Muller, MD, PhD
Joseph S Friedberg, MD
David E Midthun, MD
Deputy Editors
Kathryn A Collins, MD, PhD, FACS
Sadhna R Vora, MD


Benign or malignant mediastinal masses can develop from structures that are normally located in the mediastinum or that pass through the mediastinum during development, as well as from metastases of malignancies that arise elsewhere in the body. The approach to a patient with a mediastinal mass will be reviewed here, including planning the diagnostic work-up as well as initial therapy. In addition, a brief overview of the most common causes of mediastinal masses is presented. Detailed discussions of those pathologic processes are presented separately, as noted below.


Incidental finding on imaging — A mediastinal mass can be an incidental finding in patients who undergo plain chest radiography or advanced imaging studies, such as computed tomography or magnetic resonance imaging. These may have been obtained prior to elective surgery or as part of the evaluation of an unrelated condition.

Findings on the chest radiograph can vary from subtle mediastinal findings on anteroposterior (image 1) or posteroanterior view to the obvious presence of a widened mediastinum or an obvious large mass in the mediastinum (image 2).

Symptoms — Symptoms, if present, may be due to direct effects of the mediastinal mass or to systemic effects of the illness. In general, malignant lesions are more likely to be symptomatic.

Mediastinal mass effects – Direct involvement or compression of normal mediastinal structures cause a wide range of symptoms. These can include cough, stridor, hemoptysis, shortness of breath, pain, dysphagia, hoarseness, facial and/or upper extremity swelling due to vascular compression (eg, superior vena cava syndrome), hypotension due to tamponade or cardiac compression, and Horner syndrome due to sympathetic chain involvement.

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Literature review current through: Nov 2017. | This topic last updated: Sep 28, 2016.
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