Middle Mediastinal Mass

Masses generally arise from structures posterior to the heart. You can use the mnemonic LATTE

to remember these structures.

L - Lymph nodes

A - Aorta

T - Trachea, bronchi

T - Tumor

E - Esophagus

The differential of these anatomic regions includes the following.

Lymph nodes

Lymph node enlargement (most are malignant)

o Adenopathy

Neoplastic Adenopathy

Inflammatory Adenopathy

Sarcoid; Castleman's Disease

Inhalational Disease Adenopathy

Primary Tumors

Aorta

Other vascular lesions

Trachea, bronchi

Brochogenic cyst

Inlet lesions

Tumor

Esophagus

Duplication Cysts

The following images are CXRs demonstrating a partially circumscribed mass in the left medial

chest, adjacent to the descending aortic edge.

Mediastinal mass.

mnemonic: "NOT VD"

o 90% malignant

Nodes

o tumor (mets, lymphoma/leukemia)

o infection

o inhalational dz

o Castleman dz

Tumor

o 1' lung, trachea, esophagus Ca

Vascular

o aneurysm

o hematoma

Duplication cyst

o bronchogenic, enteric, neurenteric

Hiatus Hernia

PA and lateral chest radiographs of a hiatal hernia. Left: PA chest view demonstrates a

retrocardiac lucency with well defined lateral margins. Right: Lateral radiograph shows a large

hiatal hernia in the middle mediastinum. Hiatal hernia is the most common radiographic

abnormality of the middle mediastinum.