Imaging Evaluation of Mediastinal Masses in Infants and Children

  • Edward Y. Lee

Key Points

■ The most common chest masses are located within the mediastinum in infants and children. Approximately 80% of mediastinal masses consist of malignant lymphoma, benign thymic enlargement, teratomas, foregut cysts, and neurogenic tumors in the pediatric population (moderate evidence).

■ Mediastinal masses in the pediatric population are often asymptomatic. However, infants and children may also present with clinical symptoms characteristic of a particular type of mediastinal mass (limited to moderate evidence).

■ Mediastinal masses are typically detected and localized on frontal and lateral chest radiographs, the initial imaging modality of choice. Further evaluation can be performed with ultrasound, CT, or MRI depending on a combination of clinical presentation, age of patient, and location of the mass (i.e., anterior, middle, or posterior mediastinum) (moderate evidence).

■ In infants, prominent but normal thymus can be differentiated from neoplasm or other masses by ultrasound after initial evaluation with chest radiographs (limited evidence).

■ CT and MRI have similar sensitivity for further evaluation of a mediastinal mass. While CT is preferable to MRI for evaluating lung masses and calcification in a mass, MRI is preferable to CT for evaluating chest wall involvement (limited to moderate evidence).

■ In evaluating mediastinal vascular anomalies presenting as middle mediastinal masses in pediatric population, both CT angiography (CTA) and MR angiography (MRA) are excellent diagnostic imaging tests (moderate evidence).

■ Magnetic resonance imaging (MRI) is the preferred test in evaluating posterior mediastinal masses since most are neurogenic and have possible intraspinal extension (limited evidence).

■ PET is useful in the initial staging, monitoring interim treatment response, and reassessment after completed treatment in pediatric patients with lymphoma (moderate evidence).


Positron Emission Tomography Magnetic Resonance Angiography Chest Radiograph Mediastinal Mass Duplication Cyst 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported in part by a GE-AUR Research Award, a Society of Thoracic Radiology Research Grant, and a Society for Pediatric Radiology Research Grant. The author would like to sincerely thank pediatric pulmonologist Dr. Debra Boyer and pediatric surgeon Dr. Christopher Weldon for their insightful comments and suggestions.


  1. 1.
    Heitzman ER. The Mediastinum. Berlin: Springer-Verlag, 1988.Google Scholar
  2. 2.
    McAdams HP, Erasmus JJ, Tarver RD Spritzer CE. In Haaga JR, Lanzieri CF, Gilkeson RC (eds.). CT and MR Imaging of the Whole Body, 4th ed. St. Louis, MO: Mosby Inc., 2003:937–996.Google Scholar
  3. 3.
    Webb WR. In Webb WR, Higgins CB (eds.). Thoracic Imaging, 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2005:175–270.Google Scholar
  4. 4.
    Merten DF. AJR 1992; 158(4):825–832.PubMedGoogle Scholar
  5. 5.
    Meza MP, Benson M, Slovis TL. Radiol Clin North Am 1993; 31(3):583–604.PubMedGoogle Scholar
  6. 6.
    Buckley JA, Vaughn DD, Jabra AA et al. Crit Rev Diagn Imaging 1998; 39(5):365–392.PubMedGoogle Scholar
  7. 7.
    Laurent F, Latrabe V, Lecesne R et al. Eur Radiol 1998; 8(7):1148–1159.PubMedGoogle Scholar
  8. 8.
    Erasmus JJ, McAdams HP, Donnelly LF, Spritzer CE. Magn Reson Imaging Clin North Am 2000; 8(1):59–89.Google Scholar
  9. 9.
    Williams HJ, Alton HM. Paediatr Respir Rev 2003; 4(1):55–66.PubMedGoogle Scholar
  10. 10.
    Whitten CR, Khan S, Munneke GJ, Grubnic S. Radiographics 2007; 27(3):657–671.PubMedGoogle Scholar
  11. 11.
    Simpson I, Campbell PE. Prog Pediatr Surg 1991; 27:92–126.PubMedGoogle Scholar
  12. 12.
    Grosfeld JL, Skinner MA, Rescorla FJ et al. Ann Surg Oncol 1994; 1(2):121–127.PubMedGoogle Scholar
  13. 13.
    Brown LR, Aughenbaugh GL. AJR 1991; 157(6):1171–1180.PubMedGoogle Scholar
  14. 14.
    Jaggers J, Balsara K. Semin Thorac Cardiovasc Surg 2004; 16(3):201–208.PubMedGoogle Scholar
  15. 15.
    Billmire DF. Semin Pediatr Surg 1999; 8(2): 85–91.PubMedGoogle Scholar
  16. 16.
    Billmire DF. Semin Pediatr Surg 2006; 15(1): 30–36.PubMedGoogle Scholar
  17. 17.
    Billmire DF. Surg Clin North Am 2006; 86(2):489–503.PubMedGoogle Scholar
  18. 18.
    Billmire D, Vinocur C, Rescorla F et al. J Pediatr Surg 2001; 36(1):18–24.PubMedGoogle Scholar
  19. 19.
    Dominguez-Malagon H, Perez Montiel D. Semin Diagn Pathol 2005; 22(3):230–240.PubMedGoogle Scholar
  20. 20.
    Kanemitsu Y, Nakayama H, Asamura H et al. Surg Today 1999; 29(11):1201–1205.PubMedGoogle Scholar
  21. 21.
    Berrocal T, Madrid C, Novo S et al. Radiographics 2004; 24(1):e17.PubMedGoogle Scholar
  22. 22.
    McLaughlin RB Jr, Wetmore RF, Tavill MA et al. Laryngoscope 1999; 109(2 pt 1):312–319.PubMedGoogle Scholar
  23. 23.
    Jeung MY, Gasser B, Gangi A et al. Radiographics 2002; 22 Spec No:S79–S93.Google Scholar
  24. 24.
    Lee JY, Lee KS, Han J et al. J Comput Assist Tomogr 1999; 23(3):399–406.PubMedGoogle Scholar
  25. 25.
    King RM, Telander RL, Smithson WA et al. J Pediatr Surg 1982; 17:512–520.PubMedGoogle Scholar
  26. 26.
    Pokorny WJ, Sherman JO. J Thorac Cardiovasc Surg 1974; 68(6):869–875.PubMedGoogle Scholar
  27. 27.
    Ravitch MM. In Welch KJ, Randolph JG, Ravitch MM, O’Neill JA Jr, Rowe MI (eds.). Pediatric Surgery, 4th ed. Chicago: Year Book Medical, 1986; 602–618.Google Scholar
  28. 28.
    Incidence Rates, Lymphoma. Childhood Cancer, Chapter II: Rates and Risk Factors for Specific Childhood Cancers, Published February 1999. Accessed July 10, 2008.
  29. 29.
    Siegel MJ. In Siegel MJ (ed.). Pediatric Body CT. Philadelphia: Lippincott Williams & Wilkins, 2008; 37–39.Google Scholar
  30. 30.
    Siegel MJ, Sagel SS, Reed K. Radiology 1982; 142(1):149–155.PubMedGoogle Scholar
  31. 31.
    von Schulthess GK, McMurdo K, Tsholakoff D et al. Radiology 1986; 158(2):289–296.Google Scholar
  32. 32.
    Siegel MJ, Nadel SN, Glazer HS, Sagel SS. Radiology 1986; 160(1):241–244.PubMedGoogle Scholar
  33. 33.
    Casamassima F, Villari N, Fargnoli R et al. Radiother Oncol 1988; 11(1):21–29.PubMedGoogle Scholar
  34. 34.
    Kornreich L, Horev G, Ziv N, Grunebaum M. Eur J Pediatr 1992; 151(1):38–41.PubMedGoogle Scholar
  35. 35.
    Wernecke K, Potter R, Peters PE, Koch P. AJR 1988; 150(5):1021–1026.PubMedGoogle Scholar
  36. 36.
    Wernecke K, Vassallo P, Potter R, Luckener HG, Peters PE. Radiology 1990; 175:137–143.PubMedGoogle Scholar
  37. 37.
    Kawashima A, Fishman Ek, Kuhlman JE, Nixon MS. Radiographics 1991; 11(6): 1045–1067.PubMedGoogle Scholar
  38. 38.
    Batra P, Brown K, Collins JD et al. J Natl Med Assoc 1991; 83(11):969–974.PubMedGoogle Scholar
  39. 39.
    Stein SM, Cox JL, Hernanz-Schulman M, Kirchner SG, Heller RM. South Med J 1992; 85(7): 735–742.PubMedGoogle Scholar
  40. 40.
    Ikezoe J, Takeuchi N, Johkoh T et al. Radiat Med 1992; 10(5):176–183.PubMedGoogle Scholar
  41. 41.
    Batra P, Brown K, Steckel R. Am J Surg 1988; 156(1):4–10.PubMedGoogle Scholar
  42. 42.
    Duwe BV, Sterman DH, Musani AI. Chest 2005; 128(4):2893–2909.PubMedGoogle Scholar
  43. 43.
    Bower RJ, Kiesewetter WB. Arch Surg 1977; 112(8):1003–1009.PubMedGoogle Scholar
  44. 44.
    Harris GJ, Harman PK, Trinkle JK, Grover FL. Ann Thorac Surg 1987; 44(3):238–241.PubMedGoogle Scholar
  45. 45.
    Ahrens B, Wit J, Schmitt M et al. J Thorac Cardiovasc Surg 2001; 122(5):1021–1023.PubMedGoogle Scholar
  46. 46.
    Grosfeld JL, Baehner RL. World J Surg 1980; 4(1):29–37.PubMedGoogle Scholar
  47. 47.
    Posner JB. J Pediatr Hematol Oncol 2004; 26(9):553–554.PubMedGoogle Scholar
  48. 48.
    Janss A, Sladky J, Chatten J, Johnson J. Med Pediatr Oncol 1996; 26(4):272–279.PubMedGoogle Scholar
  49. 49.
    Mahoney NR, Liu GT, Menacker SJ et al. Am J Ophthalmol 2006; 142(4):651–659.PubMedGoogle Scholar
  50. 50.
    Zafeiriou DI, Economou M, Koliouskas D et al. Eur J Paediatr Neurol 2006; 10(2):90–92.PubMedGoogle Scholar
  51. 51.
    Ribet ME, Cardot GR. Ann Thorac Surg 1994; 58(4):1091–1095.PubMedGoogle Scholar
  52. 52.
    Adegboye VO, Brimmo AI, Adebo OA et al. West Afr J Med 2003; 22(2):156–160.PubMedGoogle Scholar
  53. 53.
    Ahn JM, Lee KS, Goo JM et al. J Thorac Imaging 1996; 11(4):265–271.PubMedGoogle Scholar
  54. 54.
    Kim OH, Kim WS, Kim MJ et al. Radiographics 2000; 20:653–671.PubMedGoogle Scholar
  55. 55.
    Liu P, Daneman A, Stringer DA. Can Assoc Radiol J 1988; 39:198–203.PubMedGoogle Scholar
  56. 56.
    Liang CD, Huang SC. J Formos Med Assoc 1997; 96(9):700–703.PubMedGoogle Scholar
  57. 57.
    Adam EJ, Ignotus PI. AJR 1993; 161(1):153–155.PubMedGoogle Scholar
  58. 58.
    Ginaldi S, Cunningham G, Davis LJ, Singleton EB. J Comput Tomogr 1981; 5(6):511–518.PubMedGoogle Scholar
  59. 59.
    Graeber GM, Shriver CD, Albus RA et al. J Thorac Cardiovasc Surg 1986; 91(5):662–666.PubMedGoogle Scholar
  60. 60.
    Lee EY, Siegel MJ. J Thorac Imaging 2007; 22(3):300–309.PubMedGoogle Scholar
  61. 61.
    Lee EY, Siegel MJ. In Boiselle PM, Lynch DA (eds.). CT of the Airways. Totowa, NJ: Humana, 2008; 351–380.Google Scholar
  62. 62.
    Lee EY, Boiselle PM, Cleveland RH. Radiology 2008; 247:632–648.PubMedGoogle Scholar
  63. 63.
    Lee EY, Siegel MJ, Hildebolt CF et al. AJR 2004; 182(3):777–784.PubMedGoogle Scholar
  64. 64.
    Webb WR, Gamsu G, Stark DD, Moon KL, Moore EH. AJR 1984; 143:723–727.PubMedGoogle Scholar
  65. 65.
    Gamsu G, Stark DD, Webb WR, Moore EH, Sheldon PE. Radiology 1984; 151:709–713.PubMedGoogle Scholar
  66. 66.
    Nakata H, Egashira K, Watanabe H et al. J Comput Assist Tomogr 1993; 17(2):267–270.PubMedGoogle Scholar
  67. 67.
    Gaeta M, Vinci S, Minutoli F et al. Eur Radiol 2002; 12:181–189.PubMedGoogle Scholar
  68. 68.
    Murayama S, Murakami J, Watanabe H et al. J Comput Assist Tomogr 1995; 19(2):188–191.PubMedGoogle Scholar
  69. 69.
    Neimatallah MA, Ho VB, Dong Q et al. J Magn Reson Imaging 1999; 10(5):758–770.PubMedGoogle Scholar
  70. 70.
    Hernandez RJ. Magn Reson Imaging Clin North Am 2002; 10(2):237–251.Google Scholar
  71. 71.
    Ho VB, Corse WR, Hood MN, Rowedder AM. Semin Ultrasound CT MR 2003; 24(4):192–216.PubMedGoogle Scholar
  72. 72.
    Russo V, Renzulli M, La Palombara C, Fattori R. Eur Radiol 2006; 16:676–684.PubMedGoogle Scholar
  73. 73.
    Shankar A, Fiumara F, Pinkerton R. Eur J Cancer 2008; 44(5):663–673.PubMedGoogle Scholar
  74. 74.
    Montravers F, McNamara D, Landman-Parker J et al. Eur J Nucl Med Mol Imaging 2002; 29(9):1155–1165.PubMedGoogle Scholar
  75. 75.
    Hudson MM, Krasin MJ, Kaste SC. Pediatr Radiol 2004; 34(3):190–198.PubMedGoogle Scholar
  76. 76.
    Wegner EA, Barrington SF, Kingston JE et al. Eur J Nucl Med Mol Imaging 2005; 32(1):23–30.PubMedGoogle Scholar
  77. 77.
    Depas G, De Barsy C, Jerusalem G et al. J Nucl Med Mol Imaging 2005; 32(1):31–38.Google Scholar
  78. 78.
    Hermann S, Warmanns D, Pixberg M et al. Nuklearmedizin 2005; 44(1):1–7.PubMedGoogle Scholar
  79. 79.
    Tatsumi M, Cohade C, Nakamoto Y, Fishman EK, Wahl RL. Radiology 2005; 237(3):1038–1045.PubMedGoogle Scholar
  80. 80.
    Kabickova E, Sumerauer D, Cumlivska E et al. Eur J Nucl Med Mol Imaging 2006; 33(9): 1025–1031.PubMedGoogle Scholar
  81. 81.
    Amthauer H, Furth C, Denecke T et al. Klin Padiatr 2005; 217(6):327–333.PubMedGoogle Scholar
  82. 82.
    Jerusalem G, Beguin Y, Fassotte MF et al. Blood 1999; 94:429–433.PubMedGoogle Scholar
  83. 83.
    Canellos GP. J Clin Oncol 1988; 6:931–933.PubMedGoogle Scholar
  84. 84.
    Gdeedo A, Van Schil P, Corthouts B, Van Mieghem F, Van Meerbeeck J, Van Marck E. Eur Respir J 1997; 10:1547–1551.PubMedGoogle Scholar
  85. 85.
    Cheson BD, Horning SJ, Coiffier B et al. J Clin Oncol 1999; 17:1244–1253 [Erratum in J Clin Oncol. 2000, 18, 2351].PubMedGoogle Scholar
  86. 86.
    Kwee TC, Kwee RM, Nievelstein RA. Blood 2008; 111(2):504–516.PubMedGoogle Scholar
  87. 87.
    Nanni C, Rubello D, Castellucci P et al. Biomed Pharmacother 2006; 60(9):593–606.PubMedGoogle Scholar
  88. 88.
    Francis IR, Glazer GM, Bookstein FL, Gross BH. AJR 1985; 145:249–254.PubMedGoogle Scholar
  89. 89.
    St Amour TE, Siegel MJ, Glazer HS, Nadel SN. J Comput Assist Tomogr 1987; 11(4):645–650.PubMedGoogle Scholar
  90. 90.
    Bale PM, Sotelo-Avila C. Pediatr Pathol 1993; 13(2):181–190.PubMedGoogle Scholar
  91. 91.
    Liang CD, Huang SC. J Formos Med Assoc 1997; 96(9):700–703.PubMedGoogle Scholar
  92. 92.
    Adam EJ, Ignotus PI. AJR 1993; 161(1):153–155.PubMedGoogle Scholar
  93. 93.
    Han BK, Babcock DS, Oestreich AE. Radiology 1989; 170:471–474.PubMedGoogle Scholar
  94. 94.
    Park JJ, Kim JW, Kim JP et al. Auris Nasus Larynx 2006; 33(1):101–105.PubMedGoogle Scholar
  95. 95.
    Spigland N, Bensoussan AL, Blanchard H, Russo P. J Pediatr Surg 1990; 25(11):1196–1199.PubMedGoogle Scholar
  96. 96.
    Scott KJ, Schroeder AA, Greinwald JH Jr. Arch Otolaryngol Head Neck Surg 2002; 128(6): 714–717.PubMedGoogle Scholar
  97. 97.
    De Foer B, Vercruysse JP, Marien P et al. JBR-BTR 2007; 90(4):281–283.PubMedGoogle Scholar
  98. 98.
    Tovi F, Mares AJ. Am J Surg 1978; 136(5): 631–637.PubMedGoogle Scholar
  99. 99.
    Koumanidou C, Vakaki M, Theophanopoulou M et al. Pediatr Radiol 1998; 28:987–989.PubMedGoogle Scholar
  100. 100.
    Krysta MM, Gorecki WJ, Miezynski WH. J Pediatr Surg 1998; 33(4):632–634.PubMedGoogle Scholar
  101. 101.
    Cohen MD, Weber TR, Sequeira FW, Vane DW, King H. Radiology 1983; 146(3):691–692.PubMedGoogle Scholar
  102. 102.
    Cory DA, Cohen MD, Smith JA. Radiology 1987; 162(2):457–459.PubMedGoogle Scholar
  103. 103.
    Slovis TL, Meza M, Kuhn JP. Pediatr Radiol 1992; 22(7):490–492.PubMedGoogle Scholar
  104. 104.
    Bergin CJ, Healy MV, Zincone GE, Castellino RA. J Comput Assist Tomogr 1990; 14(6): 928–932.PubMedGoogle Scholar
  105. 105.
    Kersting-Sommerhoff BA, Sechtem UP, Fisher MR, Higgins CB. AJR 1987; 149(1):9–13.PubMedGoogle Scholar
  106. 106.
    Greil GF, Kramer U, Dammann F et al. Pediatr Radiol 2005; 35(4):396–401.PubMedGoogle Scholar
  107. 107.
    Eichhorn J, Fink C, Delorme S, Ulmer H. Z Kardiol 2004; 93:201–208.PubMedGoogle Scholar
  108. 108.
    Russo V, Renzulli M, Buttazzi K, Fattori R. Eur Radiol 2006; 16:852–865.PubMedGoogle Scholar
  109. 109.
    Slovis TL, Meza MP, Cushing B et al. Pediatr Radiol 1997; 27(3):273–275.PubMedGoogle Scholar
  110. 110.
    Akwari OE, Payne WS, Onofrio BM, Dines DE, Muhm JR. Mayo Clin Proc 1978; 53:353–358.PubMedGoogle Scholar
  111. 111.
    Miller E, Metser U, Avrahami G, et al. J Comput Assist Tomogr 2006; 30:689–694.PubMedGoogle Scholar
  112. 112.
    Furth C, Denecke T, Steffen I et al. J Pediatr Hematol Oncol 2006; 28:501–512.PubMedGoogle Scholar
  113. 113.
    Edeline V, Bonardel G, Brisse H et al. Leuk Lymphoma 2007; 48:823–826.PubMedGoogle Scholar
  114. 114.
    Hernandez-Pampaloni M, Takalkar A, Yu JQ, Zhuang H, Alavi A. Pediatr Radiol 2006; 36:524–531.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of RadiologyChildren’s Hospital Boston, Harvard Medical SchoolBostonUSA

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