🫁 Mediastinal Mass · Anterior · Middle · Posterior · Lymphoma · Neuroblastoma · Teratoma

Schwartz Clinical Handbook — Chapter 52 · Superior vena cava syndrome · Lymphoma (Hodgkin, NHL) · Neuroblastoma · Germ cell tumor · Thymus

Select location (anterior, middle, posterior), respiratory symptoms (orthopnea, cough, stridor), SVC syndrome (facial swelling, dilated neck veins), neurologic signs (Horner, cord compression), and systemic symptoms (fever, weight loss) → differentiate thymic hyperplasia, lymphoma, germ cell tumor, neuroblastoma, foregut cyst, or TB.
⚠️ Red flags: orthopnea, SVC syndrome, tracheal compression → avoid sedation, urgent CT/biopsy under local, treat with steroids/chemotherapy before general anesthesia.

📋 Step 1 — Location & compressive symptoms
📌 Diagnostic impressions
📖 Schwartz Ch 52

Select compartment (anterior, middle, posterior), respiratory distress, SVC syndrome, Horner syndrome, cord compression, calcifications, and B symptoms → differential includes anterior: thymus (normal), lymphoma, germ cell; middle: foregut cyst, TB, sarcoid; posterior: neuroblastoma, ganglioneuroma, esophageal duplication.

✔️ Anterior: lymphoma (Hodgkin, lymphoblastic), thymoma, germ cell.
✔️ Middle: bronchogenic cyst, TB lymphadenopathy.
✔️ Posterior: neuroblastoma (children <5y), ganglioneuroma, neurofibroma.
✔️ SVC syndrome: facial plethora, dilated chest veins, respiratory distress.
📘 Schwartz pearls (Chapter 52)
• SVC syndrome: life‑threatening; avoid general anesthesia, consider steroids / low‑dose radiation before biopsy.
• Neuroblastoma: urine VMA/HVA elevated, may have opsoclonus‑myoclonus.
• Lymphoma: excisional biopsy, CXR shows mediastinal widening.
• Thymic enlargement in young children often normal (stress/thymic rebound).
• For posterior masses, MRI to evaluate intraspinal extension.