Imaging Evaluation of Mediastinal Masses in Infants and Children


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.


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Authors and Affiliations

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

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