- EPIDEMIOLOGICAL AND CLINICAL FEATURES [Tab.1]
Forty-eight patients were included in our study (30 males and 18 females - Sex-Ratio=1,67).
The average age was 08 years (range: months to 12 years).
The clinical symptomatology was dominated by Dyspnea (100%),
chest pain (81,5%) and signs of mediastinal compression (75%).
Chest X-ray revealed mediastinal enlargement in 42 cases (87.5%).
The anterior localization was noted in 29 cases (60.4%).
Chest CT-Scan was the cornerstone in the differential diagnosis of the mediastinal masses,
by identifying their location (anterior,
middle or posterior mediastinum) [fig.2],
their attenuation (soft tissue,
fat,
fluid,
+/- calcifications),
and kinetic of enhancement.
a.
Location:
In our study,
the anterior location of mediastinal masses was noted in 31 cases (44%).
The middle (23%) and the posterior (33%) locations were less represented [fig.3].
Anterior mediastinal masses were represented by thymomas (25%)[fig.4],
lymphomas (8,4%) [fig.5],
teratomas (8,4%) and lymphangiomas (6,2%) [fig.6].
Mediastinal lymphadenopathy caused by lymphoma (14,6%),
bronchogenic cysts (6,2%) [fig.7] and teratoma (3,1%) [fig.8] were located in the middle mediastinum.
Posterior mediastinal masses were divided into neuroblastomas (25%)[fig.9] ,
ganglioneuromas [fig.10] (4,2%) and esophageal duplications (4,2%) [fig.11].
b.
Density:
Density on CT-scan was helpful in the differential diagnosis process of the anterior and middle mediastinum masses.
Kinetic enhancement besides local invasion helped to differentiate between anterior lymphoma and thymic hyperplasia.
The presence of water density leads to lymphangioma diagnosis.
For the middle mediastinum masses,
low attenuation was in favor of tuberculosis or fungal infections.
Tumoral calcifications supported fungal,
osteosarcoma or tuberculosis.
- HISTOPATHOLOGICAL PROFILE:
Image-guided biopsy (ultrasound or CT) was performed in all patients; allowed to have the histological profile of our cases (Tab.2). A discrepancy between the imaging findings and histopathological data was detected only in 04 cases (12,5%) of which 02 cases were a posterior mediastinal masses.