Chapter 12 Recognizing Diseases of the Chest

TABLE 12-1 CHEST ABNORMALITIES DISCUSSED ELSEWHERE IN THIS TEXT
Topic | Appears in |
---|---|
Atelectasis | Chapter 5 |
Pleural effusion | Chapter 6 |
Pneumonia | Chapter 7 |
Pneumothorax, pneumomediastinum, and pneumopericardium | Chapter 8 |
Cardiac and thoracic aortic abnormalities | Chapter 9 |
Chest trauma | Chapter 17 |
Mediastinal Masses



• Mediastinal masses will originate in the mediastinum (makes sense, doesn’t it?), although large masses may be difficult to place.
• If a mass is surrounded by lung tissue in both the frontal and lateral projections, it lies within the lung; if a mass is surrounded by lung tissue in one but not both projections, it may be in either the lung or the mediastinum.
• In general (note that this is a generalization), the margin of a mediastinal mass is sharper than a mass originating in the lung.
Anterior Mediastinum

TABLE 12-2 ANTERIOR MEDIASTINAL MASSES (“3 Ts and an L”)
Mass | What to Look For |
---|---|
Thyroid goiter | The only anterior mediastinal mass that routinely deviates the trachea |
Lymphoma (lymphadenopathy) | Lobulated, polycyclic mass, frequently asymmetrical, that may occur in any compartment of the mediastinum |
Thymoma | Look for a well-marginated mass that may be associated with myasthenia gravis |
Teratoma | Well-marginated mass that may contain fat and calcium on CT scans |
Thyroid Masses





Lymphoma









TABLE 12-3 SARCOIDOSIS VS. LYMPHOMA
Sarcoid | Lymphoma |
---|---|
Bilateral hilar and right paratracheal adenopathy classic combination | More often mediastinal adenopathy, associated with asymmetrical hilar enlargement |
Bronchopulmonary nodes more peripheral | Hilar nodes more central |
Pleural effusion in about 5% | Pleural effusion more common—in 30% |
Anterior mediastinal adenopathy is uncommon | Anterior mediastinal adenopathy is common |
Thymic Masses




Teratoma


Middle Mediastinum


• Other malignancies that produce mediastinal lymphadenopathy include small cell lung carcinoma and metastatic disease such as from primary breast carcinoma (Fig. 12-8).
Posterior Mediastinum


Neurogenic Tumors




