Multimodality Imaging Assessment of a Giant Middle Mediastinal Schwannoma

Mediastinal schwannomas primarily originate from the intercostal and sympathetic nerves located in the posterior mediastinum. Tumors originating from the vagus nerve in the middle mediastinum are extremely rare, accounting for 2% of all intrathoracic schwannomas. Although schwannomas are typically asymptomatic and discovered by accident, they can produce symptoms when they compress adjacent structures, which may lead to severe complications and are hard to manage. These cardiovascular risk factors include superior vena cava syndrome, cardiac tamponade, heart failure, and pulmonary hypertension. Due to their widespread cystic degeneration, they are often misinterpreted as bronchogenic or pericardial cysts. Multimodality imaging can help differentiate diagnoses, determine the location and extent of the mass, and assess the involvement of other structures, which is essential for guiding surgical procedures and improving patient outcomes. The management approach is based on tumor size, location, concern for underlying malignant pathology, and potential complications related to tumor infiltration into surrounding structures. We report a case of a giant mediastinal tumor with a successful surgical resection under cardiopulmonary bypass. It was diagnosed as a schwannoma by pathological examination, more than 1 year postoperatively, with neither symptoms of postoperative neurological disorders nor signs of recurrence.