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Mediastinal Masses in Children: Radiologic-Pathologic Correlation
David M Biko1, John P Lichtenberger1, Jordan B Rapp1
1From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C).
Insights
Most pediatric chest masses occur in the mediastinum. Understanding mediastinal compartments and mass characteristics aids diagnosis for effective treatment.
Area of Science:
- Radiology
- Pediatric Oncology
- Pathology
Background:
- Pediatric mediastinal masses are frequently incidental findings on chest radiographs.
- Symptoms can include respiratory distress.
- Traditional anterior, middle, and posterior mediastinal divisions are supplemented by cross-sectional imaging classifications.
Purpose of the Study:
- To review the classification and diagnosis of pediatric mediastinal masses.
- To correlate imaging findings with mass location and pathology.
Main Methods:
- Review of cross-sectional imaging findings.
- Application of the International Thymic Malignancy Interest Group (ITMIG) classification.
- Correlation of imaging with known pathology.
Main Results:
- The mediastinum is classified into prevascular, visceral, and paravertebral compartments using ITMIG criteria.
- Prevascular masses include thymic tumors, lymphomas, germ cell tumors, and vascular tumors.
- Visceral compartment masses include lymphadenopathy and foregut-related lesions.
- Paravertebral compartment masses are most commonly neurogenic tumors.
Conclusions:
- Integrating anatomic location with imaging and pathology is crucial for diagnosing pediatric mediastinal masses.
- Accurate diagnosis guides appropriate treatment and management strategies.
Abstract:
Most pediatric masses in the chest are located in the mediastinum. These masses are often initially detected incidentally on chest radiographs in asymptomatic children, although some patients may present with respiratory symptoms. At chest radiography, the mediastinum has been anatomically divided into anterior, middle, and posterior compartments. However, with the International Thymic Malignancy Interest Group classification scheme, which is based on cross-sectional imaging findings, the mediastinum is divided into prevascular, visceral, and paravertebral compartments. In the prevascular compartment, tumors of thymic origin, lymphomas, germ cell tumors, and vascular tumors are encountered. In the visceral compartment, lymphadenopathy and masses related to the foregut are seen. In the paravertebral compartment, neurogenic tumors are most common. Using the anatomic location in combination with knowledge of the imaging and pathologic features of pediatric mediastinal masses aids in accurate diagnosis of these masses to guide treatment and management decisions. An invited commentary by Lee and Winant is available online. ©RSNA, 2021.
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