Mediastinal tuberculous lymphadenitis is a rare disease in adults. Dysphagia as the accompanying symptom is even a rarer manifestation. Cases with esophageal symptoms may present as esophageal ulceration, mucosal or submucosal mass, fistula or sinus formation, extrinsic compression or displacement of the esophagus. Extrinsic compression may radiologically or endoscopically present as a submucosal tumor. Our case is a 30-year-old woman with dysphagia for a month. Extrinsic compression was seen endoscopically on the mid-esophagus. On thoracic CT and MRI images, a multiloculated cystic/necrotic mass, 5.5×4.8×3.1 cm in size consisting of multiple septa was located subcarinally in the middle mediastinum. In Wang needle aspiration, a mucopurulaent liquid was aspirated from the subcarinal localization by bronchoscopy. Diagnostic thoracotomy was carried out because histological and bacteriological examinations were not diagnostic. It was reported as tuberculous lymphadenitis pathologically. The control thoracic CT performed after antituberculous treatment showed complete regression of the mass. We herein report a rare form of tuberculous lymphadenitis.

We report a case of paraesophageal varices presenting as a posterior Mediastinal mass in a patient with long-standing portal hypertension and cirrhosis. The case is unusual because the varices were considerably larger than those usually encountered in portal hypertension. This report is a reminder that portal hypertension with paraesophageal varices can present as a retrocardiac mass on the chest radiogram. We suggest that in diagnostic work-up of patients with cirrhosis and masses in mediastinum modern imaging techniques, such as dynamic CT, color Doppler sonography and MRI, are most helpful (because they can demonstrate the vascular nature of these masses and have multiplanar capabilities) and precutaneous needle biopsy may be hazardous.      

Foreign body aspiration (FBA) is a life-threating event in pediatric especially under 3 years of age. Chest radiography and computed tomography are the most available imaging modalities and rigid bronchoscopy is the treatment of choice. Sometimes incidental findings may be detected in the course of FBA management. In this study we report a case of 4-year-old girl who was admitted due to sudden onset of cough and cyanosis. Based on history and examination, diagnosis of foreign body aspiration was made but chest radiograph showed a round mass in the right upper hemithorax. The Foreign body was removed with Rigid bronchoscopy then the Mediastinal mass was surgically removed completely. Pathological study reported a neuroblastic tumor.

Background: Mediastinal mass is a rare presentation of tuberculosis in children. The sources of posterior Mediastinal mass are usually neurogenic tumors, infections or vascular lesions.Case Presentation: Here a 12-year-old girl is presented who manifested with a posterior Mediastinal mass extending to right paravertebral space from T3 to T8 with extension to retro cardiac and subcarinal spaces. She suffered from chronic cough, prolonged fever, and weight loss. The results of tuberculin skin test and biopsy was compatible with tuberculosis. Mediastinal tuberculosis was approved by histologic and polymerase chain reaction. The patient was treated by anti-tuberculosis drugs and surgical intervention.

1. Introduction: A 42-year old woman presented with dyspnea on exertion, exertional chest pain NYHA functional class II, weight loss, and anorexia since 2 months ago. Physical examinations were in favor of tamponade, documented by emergent echocardiography; therefore, open drainage of pericardial fluid was done. After that, transthoracic echocardiography showed moderate right ventricular enlargement with mild systolic dysfunction. Also, there were mild tricuspid regurgitations with 57 mmHg gradient and turbulent flow Pulmonary Artery (PA) bifurcation, extended to its branches.

Background: During general anesthesia in patients with Mediastinal mass compression effect on the heart, great intra thoracic vessels, or tracheal tree can lead to decrease venous return, cardiovascular collapse or tracheal obstruction. These complications may be worsened after induction of general anesthesia or prescribing muscle relaxants.Case report: A twenty one years old female with huge anterior Mediastinal mass was a candidate for right sided thoracotomy. Compression effect on the adjacent structures has been reported in chest CT scan and in echocardiography. Awake oro-tracheal intubation was performed in sitting position. Then patient positioned to left lateral decubitus for thoracotomy during surgery asystole occured. We changed the position to remove compression effect on the heart and great vessels. Fortunately these maneuvers changed asystole to sinus rhythm.Conclusion: Decreased thoracic muscular tone and removed spontaneous ventilation after muscle relaxant may threaten patient’s life. Change of patient’s position can remove the compression effect.

Right atrial dilation due to left heart disease is a common complicationamong adults. The present review aimed to describe a case of massivelydilated right atrium in a female patient presenting with valvular heartdisease and no atrial fibrillation. The results of chest X-ray revealed a largeopacity filling the lower right hemithorax, falsely interpreted as aMediastinal mass. During the transesophageal echocardiography, severeenlargement of the right atrium was detected, and open mitral andtricuspid valve replacements were performed successfully.

Background: The present study aimed to present computed tomography (CT) scan characteristics of different Mediastinal masses in children to correlate CT findings of the Mediastinal masses with histopathology; we also sought to differentiate between benign and malignant Mediastinal mass lesions based on CT findings.Method: This prospective cohort study analyzed 60 patients who underwent multi-slice CT scan for characterization of Mediastinal mass. Subsequently, imaging findings were verified with pathological diagnosis.Results: The median age of the patients was 5.3 years. The common symptoms among these patients were cough, dyspnea, chest pain, and fever. There were 24 benign (40%) and 36 (60%) malignant cases. According to their origins, 20 (33.3%) presented as neurogenic tumors, 16 (26.7%) as lymphomas, (15%) as germ cell tumors 9, and the remaining 15 (25%) as tumors: thymic pathologies, lymphangiomas, and bronchogenic cyst. 22 (36.7%) tumors were located in the posterior mediastinum, followed by 21 (35%) in the anterior mediastinum and 11 (18.3%) in the middle mediastinum.Conclusion: CT scan was found to be able to distinguish specific tissue densities and their ability to display mediastinum in axial plane. Reconstruction in sagital and coronal planes makes it a useful technique for the evaluation of a Mediastinal mass.

There has been a highly significant increase in the number of patients with malignant Mediastinal tumors in the last four decades. Since these lesions are infrequently encountered and there are very few reports in Iran concerning this issue, we performed this study to review our institutional experience of Mediastinal masses and to compare differences in the clinical spectrum between our study population and other patients studied by various reports. This was a retrospective, descriptive and cross sectional study conducted on 105 patients with Mediastinal masses who underwent surgical resection over a 5-year period from 1999 to 2003 in three major hospitals in Tehran. A total of 105 patients with Mediastinal masses including 65 males (62%) and 40 females (38%) with a mean age of 34 years (range,2-80 years) who had undergone surgery entered the study. Most Mediastinal tumors (47%) were identified in the third and fifth decades of life and the most common malignancy during the first four decades of life was malignant lymphoma. Considering the location of Mediastinal masses,the anterior mediastinum was the most common site (65%) followed by paravertebral sulci (21%) and visceral mediastinum (14%).The highest rate of malignancy was observed in visceral mediastinum (73% malignancy rate). Histopathologic evaluation of resected masses revealed twenty two types of tumors of which sixty percent were malignant. Nonspecific symptoms such as dyspnea (41%) and cough (40%) constituted the most presenting complaints. Twelve percent of patients were completely asymptomatic. The most common complication observed in this series of Mediastinal masses was Superior Vena Cava (SVC) syndrome. There was no postoperative complication. Crude mortality rate of the whole series was 16%. The prevalence of tumors in our series varied from some previously published reports. We demonstrated definite differences in histologic distribution, age range, malignancy rate and diagnostic methods of Mediastinal tumors between our study population and other reported cases which should be considered in the evaluation and planning of therapeutic modalities for Mediastinal masses encountered in our current practice.