Elsevier

Thoracic Surgery Clinics

Volume 19, Issue 1, February 2009, Pages 47-61
Thoracic Surgery Clinics

Mediastinal Tumors and Cysts in the Pediatric Population

https://doi.org/10.1016/j.thorsurg.2008.09.014Get rights and content

Pediatric mediastinal tumors and cysts are rare disorders that share many similarities with adults, yet which have important differences unique to the child. Posterior mediastinal tumors are relatively more common in children than in adults and are also more likely to be malignant in children. CT imaging facilitates the diagnostic evaluation of mediastinal masses in children. Airway compression is always a concern with large mediastinal tumors in children given their relative softer and smaller airway.

Section snippets

The Normal Pediatric Thymus

The normal pediatric thymus is relatively larger than in adults and it is important in the development of the child's immune system. It normally weighs about 15 g at birth and 35 g at puberty, at which time it involutes and is gradually replaced with fat. The size of the thymus is correlated to the weight of the infant. The generous thymus in infancy is sometimes mistaken for true pathology causing superior anterior mediastinal widening (Figs. 1 and 2). On CT, the thymus has the same density as

Teratomas

Teratomas are the most common mediastinal germ cell tumor and are composed of all three germinal layers. They are usually in the anterior mediastinum closely associated with the thymus and present with a large mass. They may also protrude into the neck from the mediastinum. They appear benign and encapsulated and they are frequently cystic (Fig. 9). They are often inhomogeneous with areas of cystic change, solid tissue, and areas of calcification. They contain mature ectodermal elements such as

Posterior mediastinal masses

Posterior mediastinal masses are most often neurogenic tumors in the paravertebralsulcus. Neurogenic tumors in children have a much higher rate of malignancy than in adults. These tumors may arise from the sympathetic ganglia (ganglioma, ganglioneuroblastoma, and neuroblastoma), the intercostal nerves (neurofibroma, neurilemoma, and neurosarcoma) and the paraganglia cells (paraganglioma).

References (29)

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