Internal Medicine

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

Mediastinal Masses 959

➣Vascular masses:

aneurysms, dilatations

➣Diaphragmatic hernia (hiatal)

■Posterior Mediastinum

➣Neural tumors:

neurofibroma, neurilemoma, neurosarcoma, ganglioneu-

roma, ganglioneuroblastoma, pheochromocytoma

➣Esophageal carcinoma, diverticuli

➣Diaphragmatic hernia (Bochdalek)

management

What to Do First

■Define location

■Look for involvement of vital structures

■Consider systemic effects (myasthenia, Cushing, hypertension)

specific therapy

■Resection:

➣Indicated for all, even benign

➣Otherwise, may enlarge and compress vital structures, become

infected, rupture

■Radiation therapy, chemotherapy:

➣Useful adjuncts to resection for some tumors

➣Seminomas are extremely radio- and chemosensitive

follow-up

■Depends on histopathology of mass

■Monitor systemic effects where appropriate – these often resolve

after resection

complications and prognosis

Complications

■Goiter – thyrotoxicosis

■HCG-secreting germ cell tumor – gynecomastia

■Parathyroid adenoma, lymphoma – hypercalcemia

■Thymoma, carcinoid – Cushing’s

■Pheochromocytoma – hypertension

■Thymoma – myasthenia gravis, RBC aplasia, myocarditis, hypogam-

maglobulinemia, other autoimmune diseases