Accounting for 40% of mediastinal masses: (N)
- Sympathetic ganglion tumors = 95% of posterior mediastinal masses (neuroblastoma / ganglioneuroblastoma / ganglioneuroma)
- Neurofibroma
- Bronchopulmonary foregut malformation (esophageal duplication, neurenteric cyst)
- Paraspinal abscess from diskitis / osteomyelitis (bacterial, tuberculous)
- Extramedullary hematopoiesis
- Dilated vessels (azygous continuation of IVC)
Approach to differential diagnosis 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 hematopoiesis, the patient must have a reason for it
Pediatric Imaging 