The mediastinum is the central part of the chest cavity. It contains the heart and its major blood vessels, the esophagus, thymus, trachea, lymph nodes and major nerves.
Different types of masses develop in the mediastinum, including benign and cancerous tumors. Because of their location in this crucial area, even benign masses can cause serious problems. The type of problem a tumor or mass can cause depends on its specific location within the mediastinum.
Anterior (front) mediastinum: Masses that form in the front part of the central chest area include:
- Thyroid tumors: these grow on the thyroid gland and are typically benign
- Thymomas: tumors of the thymus, typically benign
- Teretomas: masses of tissue that are typically benign
- Lymphoma: a cancer of lymph glands
Middle mediastinum: Masses that form in the middle of the central chest area include:
- Various cysts: typically benign growths
- Thyroid masses: such as a goiter
- Tracheal tumors: benign or cancerous masses on the trachea
Masses in this area can put pressure on the heart and its vessels, causing chest pain.
Posterior (back) mediastinum: Masses that form in the back of the central chest area include:
- Neurogenic tumors: tumors that grow in the nerve tissues and are usually benign
- Thymomas: tumors of the thymus
Tumors or masses in this area can put pressure on the spine.
Many people who have mediastinal tumors or other masses experience no symptoms. Masses are often discovered on a chest X-ray or CAT scan that is performed for another reason.
Often, a mediastinal mass is found when someone comes to the emergency room because of chest pains. Other symptoms may include:
- Persistent cough
- Shortness of breath or wheezing
- Fever or night sweats
- Difficulty swallowing or hoarseness
- Unexplained weight loss
In addition to an X-ray or CAT scan, masses are diagnosed using a scope to look inside the chest cavity, and taking a tissue biopsy.
The treatment for a mediastinal mass depends on its location and what caused it to form. Generally, they are treated with appropriate drugs and/or surgically removed.
Surgical procedures include:
- Sternotomy: the surgeon makes a large incision in the center of the chest and separates the breastbone to gain access to the mediastinum
- Thoracotomy: the surgeon makes an incision on the side or back or, in some cases, between the ribs to gain access to the chest cavity between the ribs
- Video Assisted Thoracic Surgery (VATS): tiny incisions are made in the chest, and a fiber-optic camera and tiny surgical instruments are inserted
- Robotic-assisted removal: Like VATS, tiny incisions are made in the chest — but robotic tools provide much better flexibility, and dramatically improved visuals
Swedish is one of the few centers in the Northwest to offer robotic-assisted removal of mediastinal masses. The benefits of robotic surgery include less pain, a shorter stay the hospital and a much quicker recovery.