Posterior mediastinal mass with intraspinous extension

The differential diagnosis of masses in the posterior mediastinum includes neurogenic neoplasms, cysts, esophageal tumors, infectious processes including abscesses, and disorders of the thoracic spine. Nonoperative procedures, including transcutaneous and transbronchial biopsies and thoracoscopy, may not lead to a definitive diagnosis. We present two cases in which a neurogenic tumor, with and without significant spinal canal involvement, was diagnosed at thoracotomy after several nondiagnostic procedures. The appearance of the mass on chest roentgenogram can be used to narrow the preoperative differential diagnosis between ganglion-series and nerve-sheath tumors. The utility of computerized tomography of the chest, in addition to the chest roentgenogram, in assessing the bony involvement of the thoracic tumor is illustrated. The role of magnetic resonance imaging is yet to be fully defined in this entity. These lesions may be approached by separate thoracic and neurosurgical approaches, or by a combined, single-staged procedure. These cases and a review of the literature support the use of the single-staged approach.