The place of clinical features and standard chest radiography in evaluation of mediastinal masses.

Abstract

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.