Mediastinal masses: diagnostic approach

Abstract

In most clinical situations the modern radiological approach to a mediastinal mass consists of performing a CT scan following the chest radiograph. Magnetic resonance imaging is indicated when CT findings are equivocal and as the first-line method in particular situations such as suspected involvement of the posterior mediastinum. In both techniques, tissular components of the mass assessed by density or signal intensity analysis, together with the precise location, are the leading edge of the radiological diagnosis. This review deals mainly with the differential diagnosis of primary neoplasms according to CT and MRI findings.

An asymptomatic schwannoma originating from an intercostal nerve: A case report

“…It is rarely seen in people before the age of 20. [4] The yearly [5] reported a schwannoma as a true neoplasm originating from the schwann cells which contained no neuroganglion cells. In 1935, schwannoma was defined as arising from the nerve sheaths and was also known as neuroma, neurilemmoma, or perineurofibroblastoma.…”

“…The mass is rarely calcified, inferior and superior sulci are usually present. [4,8] While bone changes on plain films are generally late manifestations of schwannomas, there are some findings that can help narrow the differential diagnosis. Bone changes, such as erosion of the ribs, may occur as well as neural foraminal enlargement and vertebral body erosion.…”

“…Malignant transformation also has been reported in 10% of schwannomatosis cases. [4] A simple complete resection is the best choice for the lesions detected radiologically which are thought to be benign. Radiotherapy applied locally may be preferable for technically incomplete, partially resectable malignant schwannomas.…”

Imaging the posterior mediastinum: a multimodality approach

“…On MRI, meningoceles are cystic masses with signal intensity of cerebrospinal fluid. This is the technique of choice for demonstrating connection of the lesion with the thecal sac, as well as for distinguishing a meningocele from a neurogenic tumor (26). Both CT and MRI are essential diagnostic tools to differentiate between coexisting lesions, such as neurinomas in patients with neurofibromatosis type 1.…”

“…On CT they appear as single homogeneous mass with regular and well-defined borders (Fig. 10) and low-to-high attenuation values, due to their fluid or proteinaceous content, respectively (25,26). They are located in the lower right part of the posterior mediastinum within the esophageal wall or closely adjacent to it (3,51).…”