18. Notes
Aortic aneurysms can be located in any compartment
Anterior masses more likely to be malignant
59% vs. 29% vs. 16%, converse is true in children
increased likelihood in 20-40 yo
Most common lesions:
Children - neurogenic tumors, enterogenous cysts
Adults - neurogenic tumors, thymomas, thymic
cysts
21. Imaging
CXR -> CT with IV contrast
MRI only recommended if pt has contrast allergy or
renal failure
useful for neurogenic tumors
Transesophageal US - posterior lymph nodes
Radionuclide scanning
123-I for thyroid, sestamibi for parathyroid,
gallium for lymphomas (replaced by FDG-PET)
22. Labs
Goiter -> TFTs
Parathyroid adenoma -> Ca, P, PTH
Paragangliomas -> urine metanephrines,
catecholamines
Neurogenic tumors -> homovanillic acid,
vanillylmandelic acid
Germ cell tumor -> AFP, B-HCG
all male pts with anterior mass
23. Management
Excision
if likely benign - teratoma, thymoma
needle aspiration, VATS, sternotomy/thoracotomy
Biopsy
lymphoma, germ cell, unresectable malignancy
surgical biopsy preferred over needle aspiration
Chest wall tumor implantation is a rare complication
24. Complications
Surgical treatment has increased risk of morbidity
2/2 central airway obstruction, greatest in those with:
Cardiorespiratory symptoms
Evidence of tracheal obstruction
Mixed obstructive & restrictive PFTs
