Mediastinal Tumors and Disease

The mediastinum is the central compartment of the thoracic cavity that is located between the two lungs and between the breastbone and the spine. The mediastinum contains the trachea (windpipe), esophagus (swallowing tube), the heart and its veins and arteries, the thymus, nerves, fat, and lymph nodes.

Mediastinal diseases are conditions that arise from tissues in this cavity. They include cancerous tumors (thymomas, lymphomas, germ cell tumors, carcinoids) and noncancerous tumors (lipoma, teratoma), masses, enlarged lymph nodes, and cysts (bronchogenic, pericardial, esophageal). Mediastinal tumors are rare but due to their location can be serious. As they grow, they can cause pressure on the heart, lungs, esophagus, trachea, and spine.

Our group of highly trained thoracic surgeons performs a range of procedures to treat mediastinal diseases – most of which can be performed minimally invasively or robotically.

Our thoracic surgeons work closely with UT Southwestern’s pulmonologists, oncologists, gastroenterologists, chest radiologists, and pathologists to deliver multidisciplinary comprehensive care – all in one location, and usually on the same day.

About Mediastinal Masses

The mediastinum has three different compartments: anterior, middle, and posterior, and different tumors, cysts, and masses tend to develop from one of these compartments.

Anterior mediastinal masses include:

• Germ cell tumors (neoplasms): These are benign in about two-thirds of cases
• Lymphoma, including Hodgkin's and non-Hodgkin's disease
• Thymic tumors and cysts: Tumors and cysts that develop in the thymus, a butterfly-shaped organ at the base of the neck and behind the breastbone
• Thyroid mass mediastinal: A benign growth such as a goiter. These masses may develop into cancer

Middle mediastinal masses include:

• Bronchogenic cysts: A fluid-filled cyst from the respiratory system
• Lymphadenopathy mediastinal: Disease in the lymph nodes
• Pericardial cysts: Fluid-filled cyst next to the pericardial sac
• Tracheal tumors

Posterior mediastinal masses include:

• Extramedullary hematopoiesis: A rare mass formed from bone marrow
• Lymphadenopathy mediastinal: Disease of the lymph nodes
• Neuroenteric cyst mediastinal: Sacs that develop outside normal esophageal tissue
• Neurogenic neoplasm mediastinal tumors: Tumors from the nerve cells

Symptoms

In nearly half of newly diagnosed patients with mediastinal tumors, masses, or cysts, there are no symptoms and they go undiagnosed until a chest X-ray or CT scan is performed, often for other reasons. Depending on the location, nature, and size of the tumor or mass, symptoms may develop due to pressure on organs inside the chest and may include:

• Chest pain
• Coughing
• Fever, chills, night sweats
• Shortness of breath
• Weight loss
• Wheezing

Diagnosis

If we suspect that you have a mediastinal disease, we will conduct a physical examination and order tests to confirm the diagnosis.

Tests and imaging techniques used to diagnose mediastinal disease might include:

• Bronchoscopy, endobronchial ultrasound (EBUS), and other interventional lung procedures
• Cardiac imaging studies
• Chest X-rays (radiographs)
• Computed tomography (CT) with 3-D reconstruction
• Esophageal endoscopic ultrasound (EUS)
• Fine-needle aspiration biopsy of a tumor or mass
• Magnetic resonance imaging (MRI)
• Mediastinoscopy
• Positron emission tomography (PET)
• Pulmonary laboratory studies
• Ultrasound

Treatments

Mediastinal tumors, masses, and cysts may be treated with surgery, chemotherapy, radiation, or a combination of these. The specific treatment will depend on the type of tissue, its location, size, and the overall health of the patient. Our multidisciplinary team of surgeons, pulmonologists, and medical and radiation oncologists works together to recommend the optimal treatment strategy for each patient.

Our surgeons are highly experienced in treating mediastinal disease with leading-edge procedures that include:

• Minimally invasive or robotic removal of tumors
• Minimally invasive or robotic removal of cysts
• Open (sternum-splitting) removal of tumors or cancers

Related Conditions

Our team treats the full range of thoracic (chest) conditions that can be associated with mediastinal disease. These include:

• Arm causalgia
• Bronchogenic cysts
• Esophageal cysts
• Hyperhidrosis, including axillary hyperhidrosis and sweaty palms
• Myasthenia gravis
• Superior vena cava syndrome
• Thymic cancer
• Thymoma

Clinical Trials

In addition to standard treatments for mediastinal disease, UT Southwestern gives patients access to the most promising new therapies through clinical trials. Talk with your doctor to see if a clinical trial may be right for you.