Superior mediastinum

1. SUPERIOR MEDIASTINUM

6. SUPERIOR MEDIASTINAL SYNDROME
• Over 80% of mediastinal masses in children are malignant.
Infants and children are more vulnerable to extrinsic airway
compression than adults.
• Non-Hodgkin lymphoma (T cell lymphoblastic lymphoma,
Burkitt's lymphoma)
• Hodgkin Disease
• Acute lymphoblastic leukaemia (ALL)
• Germ Cell Tumours - Teratoma
• Thyroid tumours, bronchogenic cysts, cystic hygroma,
granuloma and thymoma can also cause anterior
mediastinal masses.

7. SUPERIOR MEDIASTINAL SYNDROME
• Superior mediastinal syndrome involves obstruction of airways (trachea, main bronchi in particular)
and/or cardiac or great thoracic vessel compression, usually from a mediastinal mass and
represents a medical emergency.
• The onset of SVC obstruction is usually insidious but can lead to sudden loss of cardiac output and
rapid increases in intracranial pressure, with resulting cerebral oedema.
• Airway obstruction
• Main bronchus and tracheal compression produces:
• Dyspnoea, orthopnoea (breathlessness lying flat), cough, wheeze, hoarseness,stridor, chest pain,
agitation.
• pleural effusion (appears to be associated with main-stem bronchus compression)
• SVC obstruction
• duskiness/plethora of the face
• upper body swelling and venous congestion in the SVC distribution and collaterals over the chest
wall
• facial and upper body swelling with periorbital oedema (early sign)
• other symptoms such as dizziness, epistaxis, haemoptysis, nasal congestion
• drowsiness, confusion, headache, distorted vision and/or syncope are late signs associated with
cerebral oedema.
• Horner's syndrome (rare)
• ipsilateral ptosis, miosis, and anhydrosis.