ABSTRACT
Mass lesions of the mediastinum have multiple origins and may appear at any age throughout infancy, childhood, and adolescence. Management of mediastinal masses is determined by the presumed diagnosis. The preoperative diagnosis of a mediastinal mass can be established quickly with only a few diagnostic studies. The extent to which the trachea is compressed will determine the safety of anesthesia required for further diagnosis/resection. The main cystic lesions in this area are bronchogenic cysts and esophageal duplications which are typically ovoid in shape and may be suspected on routine radiographs. For extensive posterior mediastinal masses, particularly left-sided lesions, it is reasonable to consider preoperative angiography to define the artery of Adamkiewicz, as injury to this vessel has been implicated as a cause of postoperative spinal ischemia in rare instances. In cases where there is no extrathoracic tumor, either a needle biopsy with radiographic guidance or a limited anterior thoracotomy or thoracoscopy may be required to establish a tissue diagnosis.
