Lymphomas, Endocrine, Mesenchymal, and Other Rare Tumors of the Mediastinum Clinical Presentation

Updated: Feb 16, 2021
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Presentation

History and Physical Examination

A large percentage of mediastinal tumors and cysts produce no symptoms and are found incidentally during chest radiography or imaging studies of the thorax performed for other reasons. [20]  Symptoms are present in approximately one third of adult patients with a mediastinal tumor or cyst but are more commonly observed in the pediatric population, nearly two thirds of which presents with some symptoms. In adults, asymptomatic masses are more likely to be benign.

Symptoms associated with the respiratory tract predominate in pediatric patients because airway compression is more likely. This occurs because of the significant amount of malleability of the airway structures and the small size of the chest cavity in infants and children. Symptoms observed most commonly include persistent cough, dyspnea, and stridor. If the location and size of the mass produce partial or complete obstruction, obstructive pneumonia can also occur. Infectious symptomatology, and even signs of sepsis, can also occur if a mediastinal cyst becomes infected.

Constitutional symptoms such as weight loss, fever, malaise, and vague chest pain occur commonly with malignant tumors in pediatric patients.

Symptoms associated with compression of some portion of the respiratory tract can also be produced by benign lesions in adults, but this is much less likely than in children. Intrathoracic extension of a cervical goiter is one noted largely benign abnormality that commonly manifests with upper respiratory symptoms. At least 70% of individuals with intrathoracic goiters have some symptoms of airway compression. Cough, wheezing, stridor, dyspnea, and dysphagia are among the common complaints.

Infectious symptoms or sepsis from infection of a mediastinal cyst can also occur in adults, although, again, this is very unlikely in this age group.

Malignant lesions are more likely to produce signs and symptoms of obstruction and/or compression than benign lesions because they invade or transfix normal mediastinal structures. Clinical findings associated with these malignant properties include cough, dyspnea, stridor, dysphagia, and more dramatic findings (eg, superior vena cava syndrome [SVCS]).

Invasion of the chest wall or pleura by a malignant neoplasm can produce persistent pleural effusions and significant local pain. Invasion of nearby nerves within the thorax can also produce local and referred pain and various other findings such as hoarseness from recurrent nerve paralysis, diaphragmatic paralysis from phrenic nerve paralysis, Horner syndrome from autonomic nerve invasion, and even motor paralysis from direct spinal cord involvement. Pain in the shoulder or upper extremity can occur from invasion of the ipsilateral brachial plexus. Systemic findings, such as weight loss, fever, and malaise, also occur.

Mediastinal tumors that produce bioactive substances are associated with symptoms produced by those substances, as discussed in Systemic pathophysiology above.