Rationale

Mediastinal masses that are found on radiographs are classified according to location within the mediastinum, which is important for identifying the cause.

Causal Conditions

(list not exhaustive)

1. Anterior

   1. Tumours (e.g., thymoma, lymphoma)

   2. Other (e.g., aneurysm)

2. Middle

   1. Tumours (e.g., bronchogenic cancer)

   2. Other (e.g., sarcoidosis)

3. Posterior

   1. Tumours (e.g., esophageal cancer)

   2. Other (e.g., hiatal hernia)

Key Objectives

Given a patient with a mediastinal mass, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. In particular, the candidate will differentiate between causes based on radiographic compartment location, and if present, clinical signs and symptoms.

Enabling Objectives

Given a patient with mediastinal mass, the candidate will

1. interpret critical clinical findings, including those based on

   1. an appropriate history with a focus on symptoms, if any, including those due to

      • a direct mass effect (e.g., stridor, hemoptysis, facial and upper extremity swelling)

      • systemic effects (e.g., fever, night sweats, weight loss)

2. list and interpret relevant investigations, including laboratory and radiological studies;

3. construct an effective initial management plan, including

   1. determining if further investigation is required,

   2. referring the patient for specialized diagnostic tests and treatment if necessary, and

   3. counselling and educating the patient regarding the nature and scope of needed investigations.