Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases

Insights into Imaging

Helmut Prosch¹  Gilbert R. Ferretti²  Lukas Ebner³  Anne-Laure Brun⁴  Igor Letovanec⁵  Flavian Tabotta⁶  Catherine Beigelman-Aubry⁶  Justus E. Roos⁷  Samia Boussouar⁸  Michel Brauner⁹ 

[1] Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria;Department of Diagnostic and Interventional Radiology, Grenoble Alpes University Hospital, Grenoble Alpes University, 38043, Grenoble cedex, France;Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland;Department of Radiology, Cochin Hospital, Paris Descartes University, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France;Institute of Pathology, CHUV-University Hospital, Rue du Bugnon 25, CH-1011, Lausanne, Switzerland;Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland;Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Spitalstrasse 6000, Luzern 16, Switzerland;Radiology Department Pitié Salpetrière Hospital, 47-83 Boulevard de l’Hôpital, 75013, Paris, France;Service de Radiologie, Hôpital Avicenne, 125 route de Stalingrad, 93000, Bobigny, France;

关键词: Diffuse mediastinal diseases;    Mediastinum;    Pneumomediastinum;    Acute mediastinitis;    Fibrosing mediastinitis and mimickers;   

DOI  :  10.1186/s13244-020-00909-z

来源: Springer

【 摘 要 】

Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions.This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials.First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient’s history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals.Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2–3 weeks.Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.

【 授权许可】

CC BY