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What is the mediastinum?

The mediastinum is located in the chest, midway between the two lungs. The heart, trachea, esophagus, thymus and some other organs and lymph nodes are located in this region. Fluid-filled (cystic) or hard (solid) formations may develop from organs or tissues in this region, and lymph nodes in this region may develop enlargement as a symptom of another disease. Lymphoma (lymph gland cancer), tuberculosis and sarcoidosis are the most common amongst these diseases. Mediastinal lymph node enlargement may also occur due to surrounding organ cancers. In such cases, a sample (biopsy) should be taken from the lymph nodes.

Mediasten kist- kistleri nedir?
The region defined as the mediastinum is within the thorax and is located in the midline between both lungs.


What types of masses and cysts can be seen in the mediastinum?

Tumors originating from the thymus organ (thymoma or thymic cancer) located in the anterior part of this region may be present and are usually seen in adults. In the posterior part of the mediastinum, even in children, tumors originating from nerve cells (neurogenic) are seen. Since there are many different organs and tissues in the mediastinum, dozens of types of benign or malignant tumors or cysts can be seen in this region. In mediastinal masses and cysts, surgical intervention is usually necessary both to make a complete diagnosis and to treat them.

Mediastinal mass – What are the symptoms of mediastinal cyst?

Mediastinal lesions are usually silent and do not show many symptoms. As a result of the growth of these masses or cysts and pressure on the surrounding lungs, heart or large vessels, there may be symptoms including shortness of breath, chest pain, palpitations related to blood circulation, easy fatigue, swelling of the face and neck, as well as general symptoms such as fever, weight loss and weakness due to the disease.
Radiologic examinations, especially computed tomography (CT) and magnetic resonance imaging (MRI), are required and useful in mediastinal masses and cysts. Furthermore, some blood and hormone tests should also be performed to be certain.
With these examinations and images, the physician usually has a preliminary diagnosis about the mass or cyst in the mediastinum. According to possible alternative pathologies, the physician decides which treatment is more appropriate for the patient. In the majority of the cases, the treatment decision requires council meetings where physicians from many specialties make a joint evaluation and decision.
In rare cases, a definitive diagnosis can be made with these tests and the necessary medical treatment can be started without the need for biopsy or surgery.
In some cases, it may be necessary to biopsy mediastinal masses and cysts to make a full diagnosis. In diseases such as lymphoma, mediastinal tuberculosis and sarcoidosis, which are characterized by enlarged lymph nodes in the mediastinum, a biopsy is essential to make a diagnosis.
Some other mediastinal masses and cysts are more suitable for surgical removal. In cases including thymoma, teratoma, neurogenic tumor, direct surgical removal without biopsy is more appropriate.

Which interventions are performed in mediastinal masses or cysts?

For diagnostic purposes;

– Needle biopsy under tomography
– Mediastinoscopy or mediastinostomy
– Biopsies can be taken and diagnosed by videothoracoscopy (VATS).

Therapeutic surgery;

– Videothoracoscopy
– Open surgery, thoracotomy or sternotomy
The appropriate surgical approach should be chosen in accordance to the size, location and proximity to vital organs and the experience of the surgeon.


 What is Mediastinoscopies – Mediastinotomies ?

Endoscopic (mediastinoscopy) or open (mediastinotomy) procedures are used to access the mediastinum, the area in the middle of our two lungs, in front of and behind both sides of the trachea. The method is chosen according to the area of the disease and is usually performed to take a biopsy of the masses and lymph nodes in this area. It is performed through a 4 cm incision in the neck or anterior chest. It is a very commonly used method to distinguish the stage of the tumor before lung cancer surgery. It is a painless operation and the patient only needs to stay in hospital for a day.


Videothoracoscopy (VATS)

It is a closed surgery performed by entering the chest cavity through a single or 3-4 holes. In experienced and professional centers like ours, most of the mediastinal lesions are treated with the closed method surgery. The closed method has many advantages compared to open surgery methods.


Open Mediastinum Tumor Surgery

Mediastinal masses are removed by opening between the ribs through the lateral side of the chest cavity, which is called thoracotomy, or through the front of the chest, which is called sternotomy, similar to a heart surgery.

Ask Prof. Dr.
Erdal Okur

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