Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Radiologists

Abstract

Mediastinal masses are relatively uncommon, yet include a large variety of entities. Some tumors can be diagnosed with confidence based on imaging alone; others when a typical appearance is combined with the right clinical presentation. A structured approach for radiologists is presented to facilitate evaluation of patients with anterior mediastinal tumors. The approach focuses first on the more common tumors and on imaging features that strongly suggest a particular diagnosis. Discussion with the clinician can be very helpful in formulating a presumptive diagnosis. This article also discusses that confirmatory imaging or biopsy tests are most beneficial in particular situations.

Prognostic value of preoperative neutrophil-lymphocyte ratio is superior to platelet-lymphocyte ratio for survival in patients who underwent complete resection of thymic carcinoma

“…Thymic epithelial tumors (TETs), which include thymoma and thymic carcinoma, are most common tumors in the anterior mediastinum (1). Unlike thymoma, thymic carcinoma which accounts for only 0.06% of all thymic neoplasms (2) is aggressive and has a generally poor prognosis, with a 5-year survival rate of approximately 40% (3)(4)(5).…”

ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses

“…Information requested included the following: (a) preference for a three-compartment or a four-compartment model and (b) specific reasons for this preference. After drafting of a proposed multidetector CT-based compartment model by an ITMIG work group, it was further refined by an extended work group and ultimately dissemitomography (CT) and magnetic resonance (MR) imaging are predominantly used for diagnosis, evaluation, and management of mediastinal abnormalities and a growing number of mediastinal lesions are detected with multidetector CT studies performed for lung cancer screening, cardiac screening, and other purposes (9,10). Therefore, a standardized classification scheme based on multidetector CT is necessary to appropriately…”

“…Employing the existing nomenclature regarding the mediastinal compartments, slightly more than half of all mediastinal masses are located in the anterior compartment, whereas one-fourth each are identified in the middle and posterior mediastinal compartments (10,(13)(14)(15)(16)(17)(18)(19)(20)(21) many instances, localization and characterization of a mediastinal abnormality using multidetector CT are sufficient to make the diagnosis. In other cases, correlation between imaging findings and clinical context, as well as additional imaging examinations such as MR imaging and fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and histologic sampling through image-guided or surgical biopsy, is necessary to make a definitive diagnosis and guide further management.…”

“…For cases in which a definitive connection with the cervical thyroid gland cannot be identified, these other findings at multidetector CT should strongly suggest the diagnosis (Fig 2). When additional findings such as loss of mediastinal tissue planes or associated cervical or mediastinal lymphadenopathy accompany a mediastinal goiter, then thyroid malignancy should be suspected and further evaluation performed (10,36).…”

The Diagnostic Utility of Cardiac-Gated Magnetic Resonance Imaging for Assessing Surgical Resectability of Mediastinal Tumors

“…For patients with contraindications for contrast-enhanced CT (such as renal failure or contrast allergy), non-contrast MRI may be performed to characterize mediastinal tumors and evaluate involvement of vascular structures [23][24][25][26]. More importantly, cardiac-gated MRI, which is the gold standard for evaluating the pericardium [27] and heart, can provide dynamic imaging and assess the sliding motion of the tumor throughout the cardiac cycle.…”