Mediastinal tumor: what does the formation behind the sternum mean in the image?

Other names: Опухоль средостения, образование средостения, новообразование за грудиной, объёмное образование грудной клетки, опухоль переднего средостения, расширение тени средостения на рентгене

The mediastinum is the space in the center of the chest between the lungs, where the heart and large vessels, trachea, esophagus, thymus gland, nerves and lymph nodes are located. The formation here is not a diagnosis, but a finding, which can be behind many different conditions: from a harmless cyst and an enlarged lymph node due to infection to lymphoma, thymoma, germ cell or nerve tumor. A significant proportion of such formations are benign, and in adults, almost half are discovered by chance during a chest x-ray. The key to the solution is the location: anterior, middle or posterior mediastinum, since each section has its own set of probable tumors.

🧾 МКБ-10: D38.3 🏥 Where it is treated: 6 Find in the pictureLocation prompts diagnosisMany formations are benign

👨‍⚕️ Which doctor

Thoracic surgeon, oncologist, pulmonologist

🔬 Diagnostics

X-ray and CT scan of the chest with contrast, MRI, tumor markers, biopsy

💊 Treatment

Depends on the nature of the formation: surgery, chemotherapy, radiation therapy or observation

📈 Prognosis

Very different; many lesions are completely curable

⚠️ At risk

Age and gender influence the likely type of tumor; no common risk factors

⏱ When to see a doctor

Urgent - if you have shortness of breath, swelling of the face and neck, contact immediately

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Отёк лица и шеи, набухшие вены на груди, распирание в голове при наклоне
Нарастающая одышка, усиливающаяся лёжа
Осиплость голоса без простуды
Затруднение глотания и поперхивание
Лихорадка, ночная потливость и потеря веса
Опущение века и суженный зрачок с одной стороны

Three sections of the mediastinum and typical tumors

The mediastinum is conventionally divided into three parts, and this division has direct practical significance. In the anterior section, just behind the sternum, tumors of the thymus, lymphomas, substernal goiter and germ cell tumors are most often found. In the middle section, around the trachea and heart, enlarged lymph nodes due to infections and lymphomas, as well as cysts, predominate. In the posterior part, along the spine, tumors of nervous tissue are usually located - in children they are often malignant, in adults they are often benign. Therefore, the first thing the doctor evaluates on a CT scan is the exact localization.

Anterior mediastinum: thymoma, lymphoma, goiter, germ cell tumors
Middle mediastinum: lymph nodes and cysts
Posterior mediastinum: nerve tissue tumors
Location narrows the range of diagnoses
Patient age changes probabilities

Symptoms and why they are often absent

The mediastinum is quite spacious, so small formations do not interfere with the functioning of the organs for a long time and do not give rise to complaints. Symptoms appear when the tumor begins to press on neighboring structures. Compression of the trachea and bronchi causes cough and shortness of breath, the esophagus - difficulty swallowing, the recurrent nerve - hoarseness, the sympathetic nerves - drooping eyelids and constriction of the pupil. The most serious is compression of the superior vena cava with swelling of the face, neck and arms, which requires urgent help. Separately, general symptoms are distinguished: fever, sweating and weight loss, characteristic of lymphomas.

Often asymptomatic
Cough and shortness of breath due to compression of the airways
Difficulty swallowing
Hoarseness of voice
Drooping of the eyelid and constriction of the pupil
Swelling of the face and neck due to compression of the superior vena cava
Fever, sweating and weight loss in lymphomas

Diagnostics

A plain chest x-ray only reveals the expansion of the mediastinal shadow, and the main information is provided by a CT scan with intravenous contrast: it shows the location, density, presence of fat, fluid or calcifications and relationship to the vessels. MRI is particularly useful for posterior mediastinal masses and suspected spinal canal ingrowth. Young men are required to have tumor markers determined to help recognize germ cell tumors. Definitive diagnosis almost always requires obtaining tissue: a biopsy is performed through a CT-guided needle, endoscopically, or surgically.

Chest X-ray in two projections
CT chest with contrast
MRI for posterior mediastinal masses
Tumor markers in young men
Thyroid hormones for suspected goiter
CT-guided biopsy or surgery
Complete blood count and inflammatory markers

What is not a tumor

Not every mediastinal mass is a neoplasm. Cysts are often found: pericardial, bronchogenic, enterogenic - they have clear contours, liquid contents and usually require only observation. Enlarged lymph nodes occur with tuberculosis, sarcoidosis, fungal and viral infections. A retrosternally located thyroid gland, an aortic aneurysm, or a hiatal hernia can be taken as a shadow of the mediastinum. That is why the decision on treatment is never made based on the image alone, without additional studies.

Pericardial and bronchogenic cysts
Enlarged lymph nodes in tuberculosis and sarcoidosis
Substernal goiter
Aortic aneurysm
Hiatal hernia
Residual thymus tissue in young people

Treatment and observation

Tactics are completely determined by the nature of education. Benign tumors and cysts are removed when they grow, show symptoms or there is doubt about the diagnosis, and many operations today are performed minimally invasively. Lymphomas are treated with chemotherapy and radiation and do not require surgical removal—only a biopsy. Germ cell tumors are sensitive to chemotherapy, after which residual tissue is removed if necessary. Asymptomatic small cysts with a typical appearance are simply observed with repeat CT. It is impossible to independently assess the danger of a find, so consultation with a specialist is important.

Surgical removal of benign tumors and cysts
Minimally invasive thoracoscopic surgeries
Chemotherapy and radiation for lymphomas
Chemotherapy for germ cell tumors
Observation for typical asymptomatic cysts
Repeated CT scan at the appointed time
Mandatory consultation with a thoracic surgeon or oncologist

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Рентген грудной клетки (в 2 проекциях)from 150 000 МСКТ грудной клеткиfrom 350 000 АФП (альфа-фетопротеин)from 120 000 ХГЧ (хорионический гонадотропин)from 120 000 Первичная консультация пульмонолога Первичный приём онкологаfrom 250 000

Frequently asked questions: Mediastinal tumor

On the picture they wrote “expansion of the mediastinal shadow.” Is this a tumor?+

Not necessarily. This formulation only means that the shadow is wider than usual, and the cause may be enlarged lymph nodes, a cyst, a substernal thyroid gland, vascular changes, or a peculiarity in the placement of the photograph. Contrast-enhanced CT allows us to clarify the nature of the finding.

Why can’t the formation be removed immediately?+

Because for some diagnoses, primarily lymphomas, surgery is not necessary and does not improve the outcome: these tumors are treated with chemotherapy and radiation. Removal without diagnosis may be an unnecessary intervention, so the nature of the formation is first clarified.

Is mediastinal biopsy dangerous?+

This is an elective procedure performed under image guidance or endoscopically, most often with good tolerance. There is a risk of complications, but it is significantly lower than the harm from treatment without an accurate diagnosis. The biopsy method is selected according to the location of the formation.

What does swelling of the face and neck mean with a mediastinal tumor?+

This is a sign of compression of the superior vena cava, which drains blood from the head and arms. Swelling of the face, swollen veins on the chest, and a feeling of fullness when bending over appear. The condition requires urgent medical attention.

Can a mediastinal mass resolve on its own?+

Enlarged lymph nodes after an infection can actually shrink on their own, and sometimes the doctor prescribes a control CT scan after a few weeks. True tumors and cysts do not disappear on their own, so observation is always carried out as planned, and not instead of an examination.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated mediastinal tumor в Ташкенте

При выявленном образовании средостения нужны КТ с контрастированием и консультация торакального хирурга или онколога, чтобы определить природу находки. Clinics Ташкента для обследования: