These include tumors arising from the various organs and structures in the mediastinum.
• Thymic Tumours and Cysts (Thymoma, Thymic Carcinoma)
• Germ Cell Tumours
• Lymph Node Enlargement and Tumours (Lymphoma)
• Thyroid Mass that extended in to the mediastinum from behind the breast bone
• Neurogenic Tumours
• Bronchogenic cyst: This is a benign growth with respiratory origins.
• Mediastinal Lymph Node Enlargement (Lymphadenopathy)
• Tracheal (Wind Pipe) tumors
• Pericardial cyst: This is a benogn condition that results from abnormal out-pouching of the pericardium (the heart's covering layer).
• Esophageal tumors
• Vascular abnormalities: These include aortic aneurysm and aortic dissection.
Posterior (Back) Mediastinum
• Neurogenic tumors: These are the most common tumours of the posterior mediastinum and arise from the nerves in this region. Approximately 70% of neurogenic neoplasms are benign (non-cancerous)
• Lymph Node Enlargement (Lymphadenopathy)
• Cysts – Esophageal Duplication Cyst
• Thoracic Spine Abnormalities like infection or tumour.
• Vascular abnormalities: These include aortic aneurysms.
The mediastinum (from Medieval Latin mediastinus, "midway" is the central compartment of the chest cavity surrounded by loose connective tissue that separates the two lungs from each other. It contains several major structures like the heart and its vessels, the esophagus (food pipe), the trachea (wind pipe), the thymus gland and the lymph nodes of the central chest.
The Mediastinum is divided into three compartments
1. Anterior Mediastinum
Contains the thymus gland, Lymph nodes, Fat
2. Middle Mediastinum
Heart and its covering pericardium, Major Blood Vessels, The Division of the wind pipe i.e. Tracheal bifurcation
3. Posterior Mediastinum
The food pipe (Esophagus), The descending part of the major blood vessel aorta, Many Nerves like the vagus and splanchnic nerves and some lymph glands.
As much as 40 % of patients with mediastinal tumours have no symptoms. Frequently these growths are detected on a chest xray performed for another reason.
When symptoms are present they are usually due to the pressure that the tumour puts on adjacent structures such as the the spinal cord, heart or the pericardium.
These may include
• Shortness of breath
• Chest pain
• Night sweats
• Coughing up blood
• Unexplained weight loss
• Lymphadenopathy (swollen or tender lymph nodes)
• Stridor (high-pitched and noisy breathing, which could mean a blockage)
• Eye issues (drooping eyelid, small pupil) on one side of the face
• Blood tests
• Chest X-ray
• Computed tomography (CT) with an IV contrast agent
• Magnetic resonance imaging (MRI) of the chest
• Needle biopsy or aspiration or CT-guided needle biopsy
The treatment depends on the type of tumor and its location:
• Thymic Tumours require surgical removal (click here to know more)
• Lymphomas are mainly treated with chemotherapy and may be followed by radiation. However surgery may be required to obtain tissue form the tumour for diagnosis.
• Neurogenic tumors found in the posterior (back) mediastinum are treated surgically.
Minimally Invasive Surgery for Mediastinal Tumours (Thoracoscopy / VATS)
In past open surgery through a large cut in the chest either on the breast bone (Sternotomy) or on the side of chest (thoracotomy) was the only way to treat these tumours wherever surgery was required. But in todays era many of these tumours can be operated via small key hole incision by Thoracoscopy/ VATS or by using the state of art Robotic Surgery.
Click here to know more about Thoracoscopy/ VATS
Click here to know more about Robotic Surgery