Symptom >> Surgical >> Cardiothoracic Surgery

Lump formation in the tracheal space

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Mediastinal tumor, the mediastinum is located between the two sides of the lung, with the sternum and thoracic vertebra as its anterior and posterior boundaries. There are many important organs, including large blood vessels, trachea, main bronchus, pericardium, esophagus, thymus and a large number of fat, nerves and lymphatic vessels. They are mediastinal tumors due to abnormal congenital development or acquired cysts or tumors. There are many kinds of tumors inside, there are primary and metastatic, and the primary tumors are more benign, but a considerable part is malignant. In order to indicate the location of the lesion in the mediastinum, the mediastinum can be divided into several parts. The sternum and the lower edge of the fourth thoracic vertebrae are divided into upper and lower parts. The mediastinal space containing many important organs is called the visceral mediastinum (middle) In the mediastinum), the gap between the right trachea and the pericardium is the anterior mediastinum; the posterior mediastinum is called behind the trachea and pericardium (including the esophagus and the paraspinal mediastinum). According to domestic statistics, the incidence of mediastinal tumors is the first in neurogenic tumors, followed by teratoids, thymus tumors and thyroid tumors, with the fewest cystic tumors.

Cause

Cause

(1) Causes of the disease

It is caused by a variety of congenital dysplasia, such as tracheal and bronchial cysts derived from trachea or bronchial sprouts, gastric cysts and gastrointestinal cysts derived from the anterior intestine, and pericardial cysts due to abnormal development of mesodermal tissues. And cystic lymphangioma and the like. Such developmental abnormal cysts do not undergo malignant transformation; in addition, the mediastinal cysts include parasitic (such as cysticercosis) cysts, hematoma cystic changes and pancreatic pseudocysts.

(two) pathogenesis

Tracheobronchial cyst

Tracheobronchial cyst is the most common type of mediastinal congenital cyst, accounting for 40% to 50%. Most of the tracheobronchial cysts occur on the 26th to 40th day after conception. The older ones form more mediastinal masses, while the later ones form more intrapulmonary masses. Individual cases are also found in the transverse or transverse The next one. The mediastinal tracheobronchial cyst can be divided into five groups according to the location of the trachea, around the carina, paraplegia, esophageal and other parts, most of which are located around the carina, and many pedicles are connected with the atmosphere. Cysts located around the carina are prone to clinical symptoms due to compression of adjacent tissues.

2. Esophageal cyst

The esophageal cyst is derived from the anterior intestine of the embryo and is the result of failure to form a normal lumen during esophageal development.

3. Gastrointestinal cyst

Gastrointestinal cysts are rare. There are several theoretical explanations about its origin, and it is believed that the early endoderm and the notochord are not completely separated. The lining cells of the gastrointestinal cyst include gastric mucosal epithelial cells, intestinal epithelial cells, and ciliated columnar epithelial cells, wherein the gastric mucosal epithelial cells may have a secretory function, leading to peptic ulcer.

4. Pericardial cyst

Most of the pericardial cysts are congenital diseases, and in some cases, pericardial cysts can occur after many years of acute pericarditis. The pericardial cyst is generally fusiform or ovoid, with a thin wall and a clear or straw yellow liquid. The wall of the capsule is covered by a single layer of flat or columnar cells, and the cell morphology resembles mesothelial cells.

5. Thymic cyst

Thymic cysts are rare and account for only 1% to 2% of all mediastinal masses. Most of the congenital cysts from the thymic pharyngeal epithelium can occur anywhere from the neck to the descending line of the anterior mediastinum; there have also been reports of related trauma and inflammation.

Pathologically, thymic cysts should be differentiated from pseudocysts formed by thymoma and Hodgkin's disease. The pseudocyst wall is generally thick, and residual tumor tissue can be found in the fibrous wall.

Examine

an examination

Related inspection

Chest MRI chest CT examination chest B super chest perspective tracheal aspiration

1. Clinical manifestations:

In general, there are few positive signs of mediastinal tumors, and their symptoms are related to tumor size, location, growth pattern, texture, and nature. Benign tumors grow slowly and can grow to a fairly large, asymptomatic or mild condition. Conversely, malignant tumors are highly invasive and progress rapidly, and symptoms can appear at a lower time. Common symptoms include chest pain, chest tightness, cough, edema of the head and face, no sweat on one side, difficulty swallowing, etc. In addition, there may be some specific symptoms related to the nature of the tumor: such as post-sternal goiter with swallowing up and down, coughing hair-like fine hair or bean curd-like sebum as a teratoma that breaks into the lung; with myasthenia gravis Those are thymoma and the like.

2. Diagnosis:

Chest X-ray examination: an important means of diagnosing mediastinal tumors. A fluoroscopy can be performed to see if the mass moves up and down with swallowing, whether it has a morphological change with or without breathing. X-ray positive lateral chest radiograph: can show the tumor site, density, shape, edge smoothness, calcification or bone shadow. CT or nuclear magnetic resonance can further show the relationship between tumors and adjacent tissues and organs, and it is an essential examination. Cardiovascular and bronchial angiography can be performed if necessary. Ultrasound can identify substantial, vascular or cystic tumors. Radionuclides can help diagnose post-sternal goiter. A swollen lymph node biopsy of the neck. Tracheoscopy, esophagoscopy, and mediastinoscopy. Thoracoscopic: mediastinal mass biopsy. Diagnostic radiotherapy, whether it can be reduced in the short term, helps identify radioactive tumors such as malignant lymphoma.

Diagnosis

Differential diagnosis

Esophageal tracheal fistula: The respiratory organs from the trachea to the alveoli, starting from the ventral side wall of the foregut (later developed into the esophagus), began to occur in the sulcus (lung gro-ove). At some later time, the esophageal tracheal septum extending from the rear with the opening between the esophagus and the trachea is completely blocked, leaving only the throat portion. If the insufficiency is not complete, a port between the tracheal esophagus is left in the area outside the throat, which is called the esophageal tracheal fistula.

Tracheal esophageal gum-like swelling: common in esophageal syphilis disease, patients with a gum-like swelling leading to tracheal (bronchial) esophageal spasm, cough every time they eat. In addition, other symptoms of esophagitis and obstruction may also occur.

Small bronchial mucosal edema: There are inflammatory lesions, edema of the small bronchial mucosa, common in the lungs. Pulmonary bullae are generally secondary to inflammatory lesions in the bronchioles. Such as pneumonia, emphysema and tuberculosis, the most common clinical and emphysema. Pulmonary bullae secondary to pneumonia or lung abscesses are more common in infants and young children, there are single and multiple.