Retrosternal chest pain can be a symptom of a condition causing a benign noncancerous or malignant cancerous tumor in the area behind the sternum. Mediastinal lymphadenopathy — also referred to as mediastinal adenopathy — is the enlargement of the mediastinal lymph nodes. If a bacterial infection is suspected, antibiotics will most likely be prescribed. If cancer is suspected, your doctor will suggest a biopsy. A thymoma is a growth on the thymus.
Your doctor will most likely order a biopsy if a thymoma is discovered. Rarely, a thyroid will grow downward into the chest.
If cancer is detected or the growth puts too much pressure on the trachea, lungs, or blood vessels, surgical removal is typically recommended. Chest pain, retrosternal or otherwise, can be the result of a number of causes. And many of those causes are serious enough to warrant a trip to your doctor for an evaluation. Notice an unusual lump? Learn how to tell the difference between a cyst and a tumor, as well as the cancer risk associated with each.
Learn more about acid reflux, a condition that occurs when stomach acids back up into the esophagus through the lower esophageal sphincter.
Do you deal with heartburn more than twice a week? You could be dealing with GERD. Learn what causes it, and what treatment options are available. COVID and anxiety can both lead to chest pain or tightness. However, there are many less serious causes of a tight…. Tietze syndrome involves a painful swelling or lump in or around the upper ribs.
A normal thymus gland is the commonest cause of an RSS abnormality in infants. Pathological enlargement of the thymus gland can be due to a number of causes. Thymoma is the most common cause in adults [ 1 ]. Thymoma is usually seen as focal well-defined RSS asymmetric swelling with homogenous density and uniform contrast enhancement. Calcification or cystic changes may be seen. Diagnosing thymoma before the age of 30 is relatively difficult because the normal gland is variable in size.
Pleural invasion and remote pleural metastases are signs of invasive thymoma [ 1 ]. These are typically large, heterogeneous masses containing areas of necrosis and calcification demonstrating evidence of invasion of adjacent structures Figure 3 [ 2 ].
A Thymic carcinoma: Chest radiograph posteroanterior view shows well-defined mediastinal mass. B Axial CT section shows a thymic mass with necrosis located in the retrosternal location white arrow , which proved to be a thymic carcinoma.
The imaging features are the same as those of thymoma and in an advanced bulky disease thymic involvement cannot be differentiated from confluent lymph node enlargement Figure 4. A Thymic lymphoma: Lateral chest radiograph shows a mass in RSS obliterating retrosternal lucency arrow.
B Thymic lymphoma: Axial CT section shows a homogenously-attenuating lymph node mass in RSS encasing the aortic arch arrow and superior vena cava curved arrow. Although histologically distinct from thymoma, radiologically it is indistinguishable from thymoma unless it is associated with ectopic hormone production Figure 5 [ 2 ]. A Thymic carcinoid: Chest radiograph posteroanterior view shows a large anterior mediastinal mass arrow.
B Axial CT section revealed a large thymic mass with calcific focus within arrow , which proved to be thymic carcinoid on biopsy. It is a rare tumor with age range 3—60 years. It can grow to a very large size and mould itself to the mediastinum mimicking cardiomegaly or lobar collapse on X-ray. Thymolipoma: Axial CT section shows a large, insinuating retrosternal mass with areas of fat arrow suggesting thymolipoma. Congenital thymic cysts are unilocular with homogenous water attenuation.
Multilocular cysts are postulated to be inflammatory in nature. Degenerative cystic change in thymic neoplasm occasionally simulates a congenital cyst and requires histological confirmation Figure 7 [ 4 ]. A Thymic cyst: Chest radiograph posteroanterior view shows a well-defined calcified anterior mediastinal mass. B Thymic cyst: Axial CT section revealed a cystic thymic lesion arrow with calcified wall. Usually both lobes are uniformly enlarged, although occasionally it may mimic a thymic mass Figure 8.
Thymic hyperplasia: Axial CT section reveals a symmetrically enlarged thymus arrow following cessation of steroid therapy consistent with thymic hyperplasia. GCT is usually seen in second to fourth decades. They arise within or in intimate contact with the thymus. GCT includes mature teratoma, a benign and the most common mediastinal GCT, and a number of malignant forms, the most common type being seminoma Figure 9.
Cystic component may predominate Figure Seminoma: Axial CT section shows a well-defined homogenously-enhancing mass which was a biopsy-proven seminoma. Malignant GCTs are large poorly circumscribed masses. Fat and calcification are usually not seen. Bronchogenic cysts are the most common type of foregut cysts.
On CT it appears as a thin-walled fluid-attenuating lesion with or without wall calcification. Sometimes it may be hyperdense due to protein contents or milk of calcium Figure 11 [ 6 ]. The incisions are closed with stitches sutures. Why the Procedure is Performed.
Risks of anesthesia and surgery in general are: Reactions to medicines, breathing problems Bleeding, blood clots, infection Risks of retrosternal thyroid surgery are: Damage to parathyroid glands small glands near the thyroid or to their blood supply, resulting in low calcium Damage to the trachea Perforation of the esophagus Vocal cord injury. Before the Procedure. During the weeks before your surgery: You may need to have tests that show exactly where your thyroid gland is located.
This will help the surgeon find the thyroid during surgery. You may have a CT scan, ultrasound, or other imaging tests. You may also need thyroid medicine or iodine treatments 1 to 2 weeks before surgery.
Several days to a week before surgery: You may be asked to temporarily stop taking blood-thinning medicines. These include aspirin, ibuprofen Advil , naproxen Aleve , clopidogrel Plavix , warfarin Coumadin , among others. Fill any prescriptions for pain medicine and calcium you will need after surgery. Ask your provider which medicines you should still take on the day of surgery. If you smoke, try to stop.
Ask your provider for help. On the day of surgery: Follow instructions about when to stop eating and drinking. N Engl J Med 17 — Chest 4 — Article PubMed Google Scholar. Landay MJ Anterior clear space: how clear? How often? How come? Download references. Daniel B. Green, Alan C. Legasto, Ian R. You can also search for this author in PubMed Google Scholar.
Correspondence to Daniel B. Reprints and Permissions. Green, D. Pulmonary fibrosis on the lateral chest radiograph: Kerley D lines revisited. Insights Imaging 8, — Download citation. Received : 31 May Revised : 01 July Accepted : 07 July Published : 07 August Issue Date : October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
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