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.