Mediastinal Lesions/Masses

The mediastinum is the middle section of the chest cavity. It contains many vital structures, including the heart, great vessels (such as the aorta), esophagus, and trachea. The types of lesions and masses found in the mediastinum can vary depending on where they are located (anterior/front compartment, the middle mediastinum, or the posterior/back compartment). Lesions and masses in the mediastinum can be benign or cancerous. Tumors and cysts found in the mediastinum can result from a variety of causes.

The specialists in the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center are experienced in diagnosing and treating mediastinal lesions and masses. An interdisciplinary team of gastrointestinal specialists in endoscopy, radiology, and surgery works together to provide each patient with coordinated, advanced, and individualized care. Please contact our Advanced Interventional Endoscopy team to discuss your case.

Types of Mediastinal Lesions

Mediastinal Cysts

Various types of cysts can develop in the mediastinum. Although they are not actually tumors, they may compress surrounding structures and cause symptoms. They most often result from abnormal embryologic development (abnormalities that form when an embryo is first developing in the mother's uterus). Examples of mediastinal cysts include:

• Foregut cysts
• Gastroenteric cysts
• Neurenteric cysts
• Mesothelial cysts
• Bronchogenic cysts

Most of these abnormalities are considered benign. However, there have been reported cases in which cancerous tissue has been found within the wall of a bronchogenic cyst that has been surgically removed.

Mediastinal Masses

Masses that may develop in the mediastinum include neuroendocrine tumors as well as those related to esophageal cancer and lung cancer.

Symptoms of Mediastinal Lesions

Signs and symptoms associated with mediastinal masses and lesions vary according to the location of the mass. For example, a mass compressing the airway can lead to lung infection or hemoptysis (coughing up blood), while a mass compressing the esophagus can cause dysphagia (difficulty swallowing).

Other symptoms of mediastinal tumors may include:

• Chest pain
• Fever or chills
• Hoarseness
• Night sweats
• Shortness of breath
• Wheezing
• Swollen lymph nodes
• Unexplained weight loss

Because these symptoms may be associated with other medical problems, it is important to see a doctor to determine their cause.

Diagnosing Mediastinal Lesions

Mediastinal masses are usually found "incidentally" by radiologic methods such as chest x-rays, computed tomography (CT), or magnetic resonance imaging (MRI) that was being done for other reasons.

To better determine which type of mass a patient has, the CADC's advanced endoscopists use a technology known as endoscopic ultrasound (EUS). This technology makes it possible to visualize the lesion in fine detail within the mediastinum using an ultrasound device located at the tip of an endoscope. It provides real-time, close-up images of the mass. EUS also makes it possible to take samples (biopsies) of the mass with fine-needle aspiration (FNA). The tissue sampling is safe and is accomplished with a small needle inserted through the channel of the endoscope.

To learn more about these procedures, visit the Advanced Interventional Endoscopy page.

Evaluating Mediastinal Lymph Nodes

Inflammation, infection, or cancer can affect the lymph nodes in the mediastinum. EUS plus FNA is an effective means of sampling lymph nodes from the esophagus and offers a less invasive approach than surgical biopsy. This approach, which is available at the CADC, can enhance the staging of lung cancer and can be performed in conjunction with a biopsy of tissue from the bronchus.

Treatment of Mediastinal Tumors

The treatment of mediastinal tumors depends on the type and location of the tumor, though they are most often removed through surgery. Minimally invasive surgery, including video-assisted thoracic surgery and robotic approaches, has been used to treat these tumors. NewYork-Presbyterian/Weill Cornell's thoracic surgeons are highly skilled in the full range of surgical techniques.