DDX of anterior mediastinal mass

Accounting for 30% of mediastinal masses: (4 T’s)

Approach to the DDX of anterior mediastinal mass:

  • Determine if what you are seeing is a prominent thymus with symmetrically enlarged thymic lobes, if the thymic lobes are asymmetrically enlarged then consider thymoma
  • If there is fat or calcium in the mass, consider teratoma
  • If the thyroid is absent from its normal position in the neck, consider ectopic thyroid and a nuclear medicine scan
  • Otherwise surmise the mass is a lymphoma and determine where best to biopsy