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68 Cards in this Set
- Front
- Back
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What are the different compartments of the mediastinum seen on lateral plain film
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anterior
middle posterior |
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Why is it important to know the compartments of the mediastinum
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plain film (not important for CT)
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What is the boundary for the anterior mediastinum
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Anteriorly by the sternum
Posteriorly by the anterior trachea and posterior aspect of the heart |
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What r the boundaries of the middle mediastium
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anterior aspect of the trachea and posterior aspect of the heart
anterior margins of the vertebral bodies |
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What is boundaries of the posterior mediastinum
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anterior margin of the vetebral bodies and all the way back
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if there is an anterior mediastinal mass what border is going to be obliterated
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the left and right heart border
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What border of the mediastinum is directly above the right heart border
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azygous and SVC border
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What is more midline to the border of the SVC
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the right paratracheal stripe
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What part of the heart are the majority of mediastinal masses located
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anterior
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What lines will be obliterated if there is a middle mediastinal mass
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the SVC, the right paratracheal stripe and the aortic notch, the azygous esophageal recess
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When is the azygous-esophageal recess obliterated
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middle mediastinal mass
This is a line that is superimposed mid line infront of the vetebral colum and extends from the azygous vein above the right heart border to the hiatus |
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What lines are obliterated from a posterior mediastinal mass
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the descending aorta and the para spinal lines
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What is the differential diagnosis for an anterior mediastinal mass
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thymoma; thymic tumor or mass
teratoma: germ cell tumor terrible lymphoma:lymphoma or lymph node thyroid or parathyroid tons of other stuff |
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What is 'tons of other stuff'
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vascular abnormalities, foregut cyst, lymphangioma, hemangioma, mesenchymal tumor, sarcoma
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What does mesenchymal refer to
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connective tissue
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Why do you say tumor of thymic orgin instead of thymoma
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bc there are many tumors of the thymus that could cause the mass not just thymoma
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Why do you say germ cell tumor instead of teratoma
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because there are many types of germ cell tumors not just teratoma
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Do thymic tumors commonly occur in older people
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yes
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What is the mcc of thymic primary tumor
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thymic epithelial tumor
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What percent of primary mediastinal masses are thymic epithelial tumors
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15-20
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What % of pt with thymic epithelial tumors have MG
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40-50
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What % of pt with MG have thymic tumors
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10-30
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What are 2 types of thymic epithelial tumors
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thymoma
thymic carcinoma |
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What is the peak age of thymoma
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50-60
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Where do thymic epithelial tumors spread
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mcc to local lymphnodes
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Can a thymic epithelial spread to the pleura and extrathoracic
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yes
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What contours of the hear will be obliterated on plain film
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the right and left heart border
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What is the inverted horseshoe shape distribution of thymic tumors
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if you draw an inverted horseshoe around the heart this is the MC location of an thymic epithelial tumor
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What are characteristics of a thymic epithelial tumor on CT
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solid or cystic, homogenous or heterogenous, may have calcium
In other words variable |
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Where do thymic tumor typically occur
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inverted horshoe distribution
or typicaly in the prevascular space |
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Can a thymic epithelial tumor be ectopic to the neck
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yes
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What are some characteristics of a non-invasive thymoma
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perserved fat planes
smaller normal pleura solitary |
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What are some characteristics of an invasive thymoma
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absent fat planes
large hetergenous pleural effusions pleural nodules LAD |
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Where are the normal preserved fat planes located
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between heart, aorta and tumor
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Is a invasive thymoma more likely to contain calcium
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yes
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What should you think of if there is a heterogenous mass, with calcium, fat and fluid in the anterior mediastinum
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germ cell tumor
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What are 3 types of density seen in a teratoma
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fat density
soft tissue density calcifiation density |
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what % of anterior mediastinal masses are germ cell tumors
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10
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What classification does teratoma belong under
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germ cell tumor
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What are other types of germ cell tumors that may occur in the mediastinum
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seminoma, non seminoma, mixed
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What are 5% of posterior mediastinal masses
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germ cell tumors
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What % of germ cell tumors are benign
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80%
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What sex is more likely to have a malignant germ cell tumor in the anterior mediastinum
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men
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What is another name for a teratoma
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Dermoid cyst
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What the difference between a teratoma and a dermoid cyst
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no idea
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Can a teratoma rupture into the chest (pleura, lungs and mediastinum)
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yes
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What sex mc has seminoma
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men
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What percent of malignant tumors are seminoma
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20-40 % (it makes sense why guys are more likely to have a malignant germ cell tumor)
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What is the mean age for an anterior mediastinal mass that is a seminoma
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29
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What is the appearance of a seminoma on CT
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large smooth, lobulated homogenous mass
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What is the prognosis of a seminoma
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good...they are sensitive to radiation and chemotherapy
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What are non-seminomatous tumors
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mixed bag...embroynal, endodermal sinus (aka yolk sac), choriocarcinoma, etc..
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What is the prognosis for non-seminomatous tumor
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not good, tx not very effective
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What is the appearance of a non-seminomatous GCT on ct
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large, heterogneous, infiltrative
Bad |
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If the patient is 25 years old would you expect a thymic tumor
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no, too young it will probably be a GCT, thyroid or lymphoma
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What is another name for a benign enlarged thyroid
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goiter
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Does hodgkins lymphoma cause anterior mediastinal masses
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yes
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What are the two major categoreis of lymphoma
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Hodgkins
Non-Hodgkins |
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What % of pt with hodgkins lymphoma have mediastinal adenopathy
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85%
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If a pt with hodgkins has thoracic disease what % will have prevascular or paratracheal lymphnodes
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98%
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What pattern of lymphnode distribution suggest nodular sclerosing hodgkins disease
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prevascular nodes alone
50-85 % |
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Are multiple node groups commonly involved in which type of lymphoma
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hodgkins
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What percent of Non-hodgkins disease has thoracic involvement
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40-50
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Which type of lymphoma is more likely to only involve one group of lymphnodes
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non-hodgkins (40%)
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Which type of lymphoma will more commonly invade the anterior mediastinum
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hodkins
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Which type of lymphoma will more commonly invade the posterior mediastinum
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non-hodgkins
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Which type of lymphoma almost always involves the anterior mediastinum
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nodular sclerosing
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What is the ddx for cardiophrenic angle mass
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anterior mediastinal masses
pericardial cyst fatpad morgagni hernia( a type of congential diaphragmatic hernia that occurs paravetebral and is rare the MC CDH is a Bochdalek hernia 95%) lymphnode mass lipoma bronchogenic cyst |
