ABSTRACT
Mass lesions of the mediastinum have multiple origins and may appear at any age throughout infancy, childhood, and adolescence. The mass may be cystic or solid, and of either congenital or neoplastic origin. The symptoms produced by a mediastinal mass are almost as diverse as the underlying pathology of these lesions, but most symptoms are due to the ‘mass effect’ of the lesion which may compress the airway, vasculature, esophagus, or the lung. Occasionally, they present with pain resulting from inflammation produced by infection or perforation of a cyst. Invasion of the chest wall by a malignant tumor will also produce pain. Many mediastinal lesions, in fact, are found as a radiographic abnormality on a study obtained for symptoms unrelated to the mass. Respiratory symptoms of expiratory stridor, cough, dyspnea, or tachypnea require urgent investigation. Cystic or solid lesions located at the carina may produce major airway obstruction. Lesions at this site are often ‘hidden’ in the normal mediastinal shadow and may not be apparent on the anterior-posterior or lateral chest radiographs. Orthopnea and venous engorgement from superior vena caval syndrome occur with extensive involvement of the anterior mediastinum and are harbingers for respiratory obstruction upon induction of a general anesthetic. Less frequently, dysphagia from pressure on the esophagus is the presenting symptom. Neurologic symptoms from spinal cord compression or Horner’s syndrome may occur with neurogenic tumors arising in the posterior mediastinum.
