DDX of posterior mediastinal mass

Account for 40% of mediastinal masses: (N)

Approach to DDX of posterior mediastinal masses:

  • 95% of posterior mediastinal masses are sympathetic ganglion tumors which are indistinguishable on imaging: neuroblastoma, ganglioneuroblastoma, ganglioneuroma
  • A diagnosis of neurofibromatosis can be made if there are skin stigmata present or dural ectasia on imaging
  • Bronchopulmonary foregut malformations (esophageal duplication, neurenteric cyst) are usually cystic in appearance
  • Paraspinal abscess from discitis / osteomyelitis can be diagnosed in the proper clinical setting of infection, a biopsy may be necessary to isolate the organism
  • To diagnose extramedullary hematopoesis, the patient must have a reason for it