1. Middle Mediastinal Mass
Masses generally arise from structures posterior to the heart. You can use the mnemonic LATTE
to remember these structures.
L - Lymph nodes
A - Aorta
T - Trachea, bronchi
T - Tumor
E - Esophagus
The differential of these anatomic regions includes the following.
Lymph nodes
Lymph node enlargement (most are malignant)
o Adenopathy
 Neoplastic Adenopathy
 Inflammatory Adenopathy
 Sarcoid; Castleman's Disease
 Inhalational Disease Adenopathy
Primary Tumors
Aorta
Other vascular lesions
Trachea, bronchi
Brochogenic cyst
Inlet lesions
Tumor
Esophagus
Duplication Cysts

2. The following images are CXRs demonstrating a partially circumscribed mass in the left medial
chest, adjacent to the descending aortic edge.
Mediastinal mass.
mnemonic: "NOT VD"
o 90% malignant
Nodes
o tumor (mets, lymphoma/leukemia)
o infection
o inhalational dz
o Castleman dz
Tumor
o 1' lung, trachea, esophagus Ca
Vascular
o aneurysm
o hematoma
Duplication cyst
o bronchogenic, enteric, neurenteric

3. Hiatus Hernia
PA and lateral chest radiographs of a hiatal hernia. Left: PA chest view demonstrates a
retrocardiac lucency with well defined lateral margins. Right: Lateral radiograph shows a large
hiatal hernia in the middle mediastinum. Hiatal hernia is the most common radiographic
abnormality of the middle mediastinum.