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Biko DM, Lichtenberger JP, Rapp JB, Khwaja A, Huppmann AR, Chung EM. Mediastinal Masses in Children: Radiologic-Pathologic Correlation. Radiographics 2021; 41:1186-1207. [PMID: 34086496 DOI: 10.1148/rg.2021200180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Most pediatric masses in the chest are located in the mediastinum. These masses are often initially detected incidentally on chest radiographs in asymptomatic children, although some patients may present with respiratory symptoms. At chest radiography, the mediastinum has been anatomically divided into anterior, middle, and posterior compartments. However, with the International Thymic Malignancy Interest Group classification scheme, which is based on cross-sectional imaging findings, the mediastinum is divided into prevascular, visceral, and paravertebral compartments. In the prevascular compartment, tumors of thymic origin, lymphomas, germ cell tumors, and vascular tumors are encountered. In the visceral compartment, lymphadenopathy and masses related to the foregut are seen. In the paravertebral compartment, neurogenic tumors are most common. Using the anatomic location in combination with knowledge of the imaging and pathologic features of pediatric mediastinal masses aids in accurate diagnosis of these masses to guide treatment and management decisions. An invited commentary by Lee and Winant is available online. ©RSNA, 2021.
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Affiliation(s)
- David M Biko
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - John P Lichtenberger
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Jordan B Rapp
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Asef Khwaja
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Alison R Huppmann
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
| | - Ellen M Chung
- From the Pediatric Radiology Section (D.M.B., E.M.C.) and Thoracic Radiology Section (J.P.L.), American Institute for Radiologic Pathology, Silver Spring, Md; Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 (D.M.B., J.B.R., A.K.); Department of Radiology, George Washington University, Washington, DC (J.P.L.); Department of Biomedical Sciences, University of South Carolina School of Medicine, Greenville, SC (A.R.H.); and Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio (E.M.C)
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Abstract
OBJECTIVE Thoracic neurogenic neoplasms may be a diagnostic challenge both clinically and radiologically, ranging from benign, incidentally discovered tumors to aggressive, symptomatic malignancies. These tumors may originate from any nervous structure within the chest and are derived from cells of the nerve sheath, autonomic ganglia, or paraganglia. The nervous anatomy of the thorax is complex, and neurogenic tumors may be found in any mediastinal compartment or in the chest wall. Furthermore, neurogenic tumors may indicate one of many syndromes, particularly when they are multiple. CONCLUSION This article illustrates the complex anatomy of the nervous system within the chest and details important epidemiologic and pathophysiologic features as an approach to neurogenic tumors of the thorax. Key imaging features of neurogenic tumors occurring in the chest are identified, focusing on distinguishing characteristics and the relative advantages of available imaging modalities to further refine a differential diagnosis.
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