Abstract
Lesions in the middle and posterior mediastinum are relatively rare, but there are some useful radiological clues that can be used to diagnose them precisely. It is useful to determine the affected mediastinal compartment and the locations of the main thoracic nerves on medical images for diagnosing such mediastinal lesions. Neurogenic tumors can occur in the middle mediastinum, although they generally arise as posterior mediastinal tumors. Based on the above considerations, we review various characteristic imaging findings of middle and posterior mediastinal lesions, and their differential diagnoses.
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18 January 2021
In the original publication, the affiliations of authors were incorrectly published.
References
Goodman LB. Felson’s Principles of Chest Roentgenology. 3rd ed. Philadelphia: Saunders Elsevier; 2007. p. 155–174.
Fujimoto K, Hara M, Tomiyama N, Kusumoto M, Sakai F, Fujii Y. Proposal for a new mediastinal compartment classi cation of transverse plane images according to the Japanese Association for Research on the Thymus (JART) General Rules for the Study of Mediastinal Tumors. Oncol Rep. 2014;31:565–72.
Carter BW, Tomiyama N, Bhora FY, Rosado de Christenson ML, Nakajima J, Boiselle PM, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9:S97–101.
Nakazono T, Yamaguchi K, Egashira R, Takase Y, Nojiri J, Mizuguchi M, et al. CT-based mediastinal compartment classifications and differential diagnosis of mediastinal tumors. Jpn J Radiol. 2019;37:117–34.
Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, et al. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37:413–36.
Tracker PG, Mahani MG, Heider A, Lee EY. Imaging evaluation of mediastinal masses in children and andults: practical diagnostic approach based on a new classification system. J Thorac Imaging. 2015;30:247–67.
Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128:2893–909.
Jeung MY, Gasser B, Gangi A, Bogorin A, Charneau D, Wihlm JM, et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79–93.
Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32:1325–39.
Hattori H. High prevalence of estrogen and progesterone receptor expression in mediastinal cysts situated in the posterior mediastinum. Chest. 2005;128:3388–90.
Kawaguchi M, Kato H, Hara A, Suzui N, Tomita H, Miyazaki T, et al. CT and MRI characteristics for differentiating mediastinal Mullerian cysts from bronchogenic cysts. Clin Radiol. 2019;74:976.
Ko SF, Hsieh MJ, Ng SH, Lin JW, Wan YL, Lee TY, et al. Imaging spectrum of Castleman’s disease. Am J Roentgenol. 2004;182:769–75.
Madan R, Chen JH, Trotman-Dickenson B, Jacobson F, Hunsaker A. The spectrum of castleman’s disease: mimics, radiologic pathologic correlation and role of imaging in patient management. Eur J Radiol. 2012;81:123–31.
Bonekamp D, Horton KM, Hruban RH, Fishman EK. Castleman disease: the great mimic. Radiographics. 2011;31:1793–807.
Zhao S, Wan Y, Huang Z, Song B, Yu J. Imaging and clinical features of castleman disease. Cancer Imaging. 2019;19:53.
Sharma A, Fidias P, Hayman LA, Loomis SL, Taber KH, Aquino SL. Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 2004;24:419–34.
Apter S, Avigdor A, Gayer G, Portnoy O, Zissin R, Hertz M. Calcification in lymphoma occurring before therapy: CT features and clinical correlation. Am J Roentogenol. 2002;178:935–8.
Suwatanapongched T, Gierada DS. CT of thoracic lymph nodes. Part II diseases and pitfalls. Br J Radiol. 2006;79:999–1006.
Koyama T, Ueda H, Togashi K, Umeoka S, Kataoka M, Nagai S. Radiologic manifestations of sarcoidosis in various organs. Radiographics. 2004;24:87–104.
Iida Y, Konishi J, Harioka T, Misaki T, Endo K, Torizuka K. Thyroid CT number and its relationship to iodine concentration. Radiology. 1983;147:793–5.
Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med. 2005;35:266–76.
Smith JR, Oates ME. Radionuclide imaging of the parathyroid glands: patterns, pearls, and pitfalls. Radiographics. 2004;24:1101–15.
Fujita K, Nakashima K, Kumakura H, Minam K. A recurrent vagal schwannoma in the middle mediastinum after surgical enucleateion. Ann Thorac Cardiovasc Surg. 2014;20:832–5.
Pavlus JD, Carter BW, Tolley MD, Keung ES, Khorashadi L, Lichtenberger JP 3rd. Imaging of thoracic neurogenic tumors. Am J Roentgenol. 2016;207:552–61.
Aquino SL, Duncan GR, Hayman LA. Nerves of the thorax: atlas of normal and pathologic findings. Radiographics. 2001;21:1275–81.
Ozawa Y, Suzuki R, Hara M, Shibamoto Y. Identification of the pericardiacophrenic vein on CT. Cancer Imaging. 2018;5:18.
Ozawa H, Kokubun S, Aizawa T, Hoshikawa T, Kawahara C. Spinal dumbbell tumors: an analysis of a series of 118 cases. J Neurosurg Spine. 2007;7:587–93.
Meola A, Perrini P, Nicola M, di Russo P, Tiezzi G. Primary dumbbell-shaped lymphoma of the thoracic spine: a case report. Case Rep Neurol Med. 2012;2012:647682.
Nakazono T, White CS, Yamasaki F, Yamaguchi K, Egashira R, Irie H, et al. MRI findings of mediastinal neurogenic tumors. Am J Roentogenol. 2011;197:W643–W652652.
Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics. 2002;22:911–34.
Ozawa Y, Kobayashi S, Hara M, Shibamoto Y. Morphological differences between schwannomas and ganglioneuromas in the mediastinum utility of the craniocaudal length to major axis ratio. Br J Radiol. 2014;87:20130777.
Kato M, Hara M, Ozawa Y, Shimizu H, Shibamoto Y. Computed tomography and magnetic resonance imaging features of posterior mediastinal ganglioneuroma. J Thorac Imaging. 2012;27:100–6.
Guan YB, Zhang WD, Zeng QS, Chen GQ, He JX. CT and MRI findings of thoracic ganglioneuroma. Br J Radiol. 2012;85:e365–372.
Kliewer KE, Cochran AJ. A review of the histology, ultrastructure, immunohistology, and molecular biology of extra-adrenal paragangliomas. Arch Pathol Lab Med. 1989;113:1209–18.
Lee KY, Oh YW, Noh HJ, Lee YJ, Yong HS, Kang EY, et al. Extraadrenal paragangliomas of the body: imaging features. Am J Roentgenol. 2006;187:492–504.
Balcombe J, Torigian DA, Kim W, Miller WT Jr. Cross-sectional imaging of paragangliomas of the aortic body and other thoracic branchiomeric paraganglia. Am J Roentgenol. 2007;188:1054–8.
Takashima Y, Kamitani T, Kawanami S, Nagao M, Yonezawa M, Yamasaki Y, et al. Mediastinal paraganglioma. Jpn J Radiol. 2015;33:433–6.
Georgiades CS, Neyman EG, Francis IR, Sneider MB, Fishman EK. Typical and atypical presentations of extramedullary hemopoiesis. Am J Roentgenol. 2002;179:1239–43.
Orphanidou-Vlachou E, Tziakouri-Shiakalli C, Georgiades CS. Extramedullary hemopoiesis. Semin Ultrasound CT MR. 2014;35:255–62.
Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol. 2012;41:911–6.
Tsitouridis J, Stamos S, Hassapopoulou E, Tsitouridis K, Nikolopoulos P. Extramedullary paraspinal hematopoiesis in thalassemia: CT and MRI evaluation. Eur J Radiol. 1999;30:33–8.
Restrepo CS, Eraso A, Ocazionez D, Lemos J, Martinez S, Lemos DF. The diaphragmatic crura and retrocrural space: normal imaging appearance, variants, and pathologic conditions. Radiographics. 2008;28:1289–305.
Kakite S, Tanabe Y, Kinoshita F, Harada H, Ogawa T. Clinical usefulness of In-111 chloride and Tc-99m Sn colloid scintigraphy in the diagnosis of intrathoracic extramedullary hematopoiesis. Ann Nucl Med. 2005;19:317–20.
Schittenhelm J, Jacob SN, Rutczynska J, Tsiflikas I, Meyermann R, Beschorner R. Extra-adrenal paravertebral myelolipoma mimicking a thoracic schwannoma. BMJ Case Rep. 2009. https://doi.org/10.1136/bcr.07.2008.0561.
Shi Q, Pan S, Bao Y, Fan H, Diao Y. Primary mediastinal myelolipoma: a case report and literature review. J Thorac Dis. 2017;9:E219–E225225.
Xiong Y, Wang Y, Lin Y. Primary myelolipoma in posterior mediastinum. J Thorac Dis. 2014;6:E181–E187187.
Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: anatomy and function. Radiographics. 2012;32:E51–70.
Chaturvedi A, Rajiah P, Croake A, Saboo S, Chaturvedi A. Imaging of thoracic hernias: types and complications. Insights Imaging. 2018;9:989–1005.
Omer A, Engelman E, McClain J. Mediastinal extension of a pancreatic pseudocyst. Radiol Case Rep. 2018;13:1192–4.
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Ozawa, Y., Hiroshima, M., Maki, H. et al. Imaging findings of lesions in the middle and posterior mediastinum. Jpn J Radiol 39, 15–31 (2021). https://doi.org/10.1007/s11604-020-01025-0
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DOI: https://doi.org/10.1007/s11604-020-01025-0