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SUPERIOR MEDIASTINUM
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.
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.
Superior mediastinum

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Superior mediastinum

  • 2.
  • 3.
  • 4.
  • 5.
  • 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.