Mediastinal Diseases

The symptoms of mediastinal diseases depend on the nature and location of the lesion. Common symptoms include:

• Respiratory Symptoms
  - Cough, Difficulty Breathing, or Stridor:** Often caused by compression of the trachea or bronchi.
  - Chest Tightness: When tumours or vascular lesions compress the lungs.
   
• Chest Pain
  - Localized or radiating chest pain, potentially associated with infections, tumours, or aortic aneurysms.
   
• Difficulty Swallowing (Dysphagia)
  - Occurs when the lesion compresses the oesophagus, causing pain or difficulty swallowing.
   
• Hoarseness
  - Caused by recurrent laryngeal nerve compression, commonly seen in thymomas or tumour-related lymphadenopathy.
   
• Superior Vena Cava Syndrome
  - Swelling of the face, neck, or upper limbs, accompanied by distended veins, often due to tumour compression of the superior vena cava.
   
• Systemic Symptoms
  - Fever, Weight Loss, and Night Sweats:** Frequently observed in patients with infections or malignant tumours.

Mediastinal diseases are diverse in origin and are typically associated with the following factors:

Comprehensive diagnostic evaluations are necessary to identify the underlying cause and determine the extent of mediastinal diseases.

The treatment of mediastinal diseases depends on the specific cause, the nature of the disease, and the patient’s physical condition. Below are treatment approaches for different types of mediastinal diseases:

1. Infectious Diseases
Bacteria, Mycobacterium tuberculosis, or other pathogens often cause mediastinal infections or abscesses. Treatment primarily focuses on combating the infection:

• Antibiotic therapy: Used for bacterial abscesses or infections (e.g., caused by Staphylococcus or Streptococcus).
• Anti-tuberculosis therapy: Long-term anti-tuberculosis medication (6–9 months) if tuberculosis is confirmed.
• Surgical intervention: If abscesses cannot be controlled with medication, mediastinoscopy or thoracoscopy may be needed for drainage.
   

2. Benign Tumours
Benign tumours include teratomas, neurogenic tumours, and thymic-related tumours:

• Regular monitoring: Periodic imaging follow-ups (e.g., every 6–12 months) are recommended for asymptomatic and stable tumours.
• Surgical removal: For symptomatic or rapidly growing tumours, minimally invasive thoracoscopic surgery (VATS) is preferred. Complete resection is usually advised for teratomas or thymomas to avoid compression of adjacent organs or potential malignancy.

3. Malignant Tumours
Malignant tumours such as lymphoma, thymic carcinoma, or metastatic tumours require a multimodal approach:

• Chemotherapy: Lymphomas: Standard regimens like ABVD (for Hodgkin lymphoma) or CHOP (for non-Hodgkin lymphoma). Germ cell tumours: Platinum-based regimens (e.g., BEP protocol).
• Radiation therapy: Used as an adjunctive treatment post-surgery or as a primary option for inoperable cases. Effective for localized tumours or lymph node metastasis.
• Surgical treatment: Early-stage or resect-able tumours can be removed via mediastinoscopy or thoracoscopic surgery. Emergency decompression surgery may be required if the tumour compresses the superior vena cava or trachea.
• Targeted therapy and immunotherapy: Suitable for tumours with genetic mutations or specific biomarkers, such as EGFR-mutated lung cancer.
   

4. Aortic Aneurysms
Aortic aneurysms are among the most dangerous mediastinal conditions and may result in fatal bleeding:

• Medical therapy: Small aneurysms can be managed with blood pressure control medications (e.g., beta-blockers or ACE inhibitors).
• Surgical repair: Large aneurysms or those at risk of rupture are treated with open surgery or endovascular stent grafting (TEVAR).
   

5. Oesophageal-Related Diseases
These include oesophageal cancer, diverticula, or perforations:

• Surgical treatment: Oesophageal cancer is treated with combined thoracic and abdominal surgery (e.g., esophagectomy) and lymph node dissection. Symptomatic oesophageal diverticula can be surgically repaired.
• Endoscopic treatment: Endoscopic submucosal dissection (ESD) treats early-stage cancers or small lesions.
   

6. Inflammatory Mediastinal Diseases
Conditions like sarcoidosis or other immune-related inflammations:

• Medical therapy: Corticosteroids (e.g., prednisone) are used to suppress inflammation. Immunosuppressive agents (e.g., methotrexate or azathioprine) may be added for rheumatic diseases.
• Supportive therapy: Oxygen therapy for patients with associated pulmonary symptoms.
   

7. Supportive and Palliative Care
For incurable mediastinal diseases, supportive care is aimed at improving the quality of life:

• Relieving superior vena cava syndrome: Placement of venous stents to restore blood flow. Short-term corticosteroids to alleviate swelling and compression.
• Pain management: Used for chest pain or neuropathic pain associated with malignant tumours.

These treatment methods are tailored to the patient’s condition and disease characteristics, ensuring a comprehensive and practical approach to managing mediastinal diseases.