Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Measles Mediastinal Masses 957

■Diarrhea

➣Pneumonia – either primary viral or secondary bacterial

➣Laryngotracheobronchitis (croup)

➣Acute encephalitis – 0.1–0.2% of cases

■SSPE: result of persistent measles, develops years after infection

(mean incubation 7 years)

■Myocarditis/pericarditis

■death due to respiratory or neurologic complications: 1–2/1000 cases

Prevention

■acquired immunity after illness is permanent

■in U.S. vaccine recommended at 12–15 months and a 2nd dose at

school age

■reportable disease

■measles vaccine recommended in outbreak setting

MEDIASTINAL MASSES

STEPHEN C. LAZARUS, MD

history & physical

History

■Since differential diagnosis is broad, a detailed history is important

Signs & Symptoms

■<50% asymptomatic – 80% of these are benign

■Common symptoms are cough, dyspnea, dysphagia, chest pain, SVC

obstruction, hoarseness, stridor; Horner’s less common

tests

Imaging

■CXR: look for location, teeth

■Chest CT: very sensitive and specific for teratomas, thymolipomas,

fat

■MRI: can demonstrate continuity with thymus

■PET: may help identify neoplasm

Specific Tests

■Thyroid function (goiter, thyroid)

■HCG, alphaFP (germ cell tumor)

■Antiacetycholine receptor antibody (myasthenia gravis)

■99MTechnetium-Sestamibi (parathyroid)