Mediastinal masses in children: From thymic lesions to lymphomas

Most children with mediastinal masses are symptomatic. Cough, respiratory distress, and neurologic manifestations are common. Patients with lymphoma generally present with painless supraclavicular or cervical adenopathy; the nodes are firm and have a rubbery feel. A bronchogenic cyst can cause severe respiratory distress, localized wheezing, persistent infiltrates, or atelectasis in neonates or young infants. The plain chest radiograph is the most valuable tool for detecting a mass. CT scan may further define the precise anatomic location of the lesion, distinguish cystic lesions from solid tumors, and demonstrate the extent of involvement of vital structures. MRI is useful for differentiating masses in the mediastinum from vascular structure and for defining the anatomic relationship of a posterior mediastinal mass to the spine. Once the presence of a mediastinal mass has been established, surgical consultation is needed to obtain a specimen for tissue diagnosis.