Mediastinal masses. Clues to interpretation of radiologic studies

The best approach to evaluation of a mediastinal mass begins with a history and a physical examination that are oriented toward discovery of evidence of compression or obstruction to any of the mediastinal organs. Currently, the most efficient radiographic approach, after the plain chest roentgenogram, is computed tomography of the thorax, supplemented as needed by selected plain tomograms or a barium swallow examination. Unless the mass is definitely a benign lesion of no consequence, such as a pericardial fat pad, thoracotomy by an experienced thoracic surgeon is usually necessary to make a specific diagnosis and excision is performed if possible.