Middle Mediastinum

The tumors of the middle mediastinum include lymphoma, pericardial cyst, bronchial cyst and mediastinal granuloma. These can frequently be identified on CT scan. A pericardial cyst may not need treatment at all other than biopsy for identification, and if this has a classic appearance on CT scan, even this may not be necessary.

Diagnosis of lymphoma usually by anterior mediastinotomy or cervical mediastinoscopy is required. Bronchial cyst usually originates from the mainstem bronchi and usually requires resection by thoracotomy to prevent recurrent infection. Mediastinal granulomas do not need treatment unless they are actually eroding into the tracheobronchial tree, such as is the case with broncholithiasis. This generally requires thoracotomy for removal of the broncholith or rarely rigid bronchoscopy if thoracotomy is contraindicated.

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