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Mediastinal Masses

Mediastinal masses are tumors or growths that form in the area of the chest that separates the lungs. This area, called the mediastinum, is surrounded by the breastbone, spine and the lungs. It contains the heart, aorta, esophagus, thymus, trachea, lymph nodes and nerves.

Mediastinal tumors that are not treated can cause serious problems, even if they are not cancerous. Whether a patient has a benign or cancerous mediastinal mass, thoracic surgeons at WakeMed have experience and expertise in surgical procedures to remove these masses, including minimally invasive surgical techniques aided by video and robotic technology.

Symptoms of Mediastinal Masses

Many people who have mediastinal tumors experience no symptoms. Symptoms often result from the pressure put by the tumors onto surrounding structures, such as the spinal cord, heart or the heart's lining, and may include:

  • Chest pain
  • Chills
  • Cough
  • Coughing up blood
  • Eye issues (drooping eyelid, small pupil) on one side of the face
  • Fever
  • Flushing
  • Hoarseness
  • Night sweats
  • Shortness of breath
  • Stridor (high-pitched and noisy breathing, which could mean a blockage)
  • Swollen or tender lymph nodes
  • Unexplained weight loss
  • Wheezing

Types and Causes of Mediastinal Masses

Mediastinal masses are classified by where they are located, and can be benign or malignant.

Anterior (front) mediastinum

  • Lymphoma: These malignant tumors include both Hodgkin's disease and non-Hodgkin's lymphoma.
  • Thymoma and thymic cyst
  • Germ cell
  • Thyroid mass mediastinal: Usually a benign growth, such as a goiter

Middle mediastinum

  • Bronchogenic cyst: A benign growth with respiratory origins
  • Lymphadenopathy mediastinal: An enlargement of the lymph nodes
  • Pericardial cyst: A benign growth in the heart's lining
  • Tracheal tumors
  • Esophageal tumors
  • Esophageal abnormalities, including achalasia esophageal, diverticulum and hiatal hernia
  • Vascular abnormalities, including aortic aneurysm and aortic dissection

Posterior (back) mediastinum

  • Neurogenic tumors
  • Lymphadenopathy: An enlargement of the lymph nodes
  • Extramedullary haematopoiesis: A rare cause of masses that form from bone marrow expansion and are associated with severe anemia
  • Neuroenteric cyst: This rare growth involves both neural and gastrointestinal elements.
  • Paravertebral abnormalities: These include infectious, malignant and traumatic abnormalities of the thoracic spine.
  • Vascular abnormalities, including aortic aneurysms

Diagnosing Mediastinal Masses

Mediastinal masses are most often incidentally discovered on a chest X-ray or other imaging tests during an examination for chest symptoms.

WakeMed thoracic surgeons perform these procedures to diagnose mediastinal masses:

  • Biopsy
  • Mediastinoscopy: A procedure used to examine the mediastinum using a tool called a mediastinoscope – a long, thin, flexible tube that has a light and a tiny camera
  • EBUS (endobronchial ultrasound) bronchoscopy: A procedure that uses a flexible tube with a video camera and an ultrasound probe that goes through the mouth and throat to image the lungs and nearby lymph nodes

Treating Mediastinal Masses

The treatment used for mediastinal tumors depends on the type of tumor and its location. Most malignant tumors are removed surgically; some are treated with chemotherapy. Sometimes radiation therapy is also used.

WakeMed thoracic surgeons offer these procedures to treat mediastinal masses:

  • Cyst removal
  • Thymectomy, or removal of the thymus

Whenever possible, a minimally invasive approach is used, such as video-assisted thoracic surgery (VATS), a minimally invasive procedure that involves the insertion of a thoracoscope (small camera) and surgical instruments into small incisions in the chest. Minimally invasive techniques can reduce postoperative pain, shorten a patient’s hospital stay and speed up recovery time.

Make an Appointment

We welcome new patients. If you’d like to meet with one of WakeMed’s thoracic experts, please make an appointment by calling us at 919-231-6333.