Mediastinal

Spotnitz, W.D., Dalton, M.S., Baker, J.W. and Nolan, S.P, Reduction of perioperative hemorrhage by anterior mediastinal spray application of fibrin glue during cardiac operations. Ann. Thorac. Surg., 44, 529-531 (1987). 

This royal-blue-colored drug is an anthracenedione that inhibits DNA topoisomerase II. The pharmacokinetics of mitoxantrone may best be described by a three-compartment model, with an a half-life of 3 to 10 minutes, a 3 half life of 0.3 to 3 hours, and a median terminal half-life of 12 days. Biliary elimination appears to be the primary route of elimination, with less than 10% of the drug eliminated by the kidney.23 Mitoxantrone has shown clinical activity in the treatment of acute leukemias, breast and prostate cancer, and non-Hodgkin s lymphomas. Myelosuppression, mucositis, nausea and vomiting, and cardiac toxicity are side effects of this drug. The total cumulative dose limit is 160 mg/m2 for patients who have not received prior anthracycline or mediastinal radiation. Patients who have received prior doxorubicin or daunorubicin therapy should not receive a cumulative dose greater than 120 mg/m2 of mitoxantrone. Patients should be counseled that their urine will turn a blue-green color. 

A 22-year-old female college student with no remarkable medical history notes shortness of breath when she takes her daily 5-mile run, which has worsened progressively over the past 3 weeks. On review of systems, it is discovered that she has experienced intermittent sensations of chest tightness over the past 2 months that she ascribed to pollen allergies, and 3 days prior to presentation she experienced an episode of hemoptysis. Her only medication is oral contraceptives, and she reports no known drug allergies. A chest x-ray is remarkable for a 10 x 12 cm mediastinal mass. 

Is this age group at risk for a particular malignant diagnosis that presents as a mediastinal mass ... 

Shortness of breath, dry cough, chest pressure (patients with mediastinal mass)... 

Cytotoxic chemotherapy is the treatment of choice for chemotherapy-sensitive tumors such as SCLC and lymphoma. As indicated earlier, chemotherapy also may be combined with radiotherapy, especially in patients with lymphoma who have bulky mediastinal lymphadenopathy. 

Mediastinitis Inflammation of the midline partition of the chest cavity. 

Figure 13.1 (a) and (b) showing an endobronchial ultrasound (EBUS)-FNA biopsy of an enlarged mediastinal lymph node from a 63-year-old male with a left lower lobe lung mass and a remote history of melanoma. (See text for full caption). 

Suggested Alternatives for Differential Diagnosis Abdominal aneurysm, aortic dissection, pleural effusion, subarachnoid hemorrhage, superior vena cava syndrome, hantavirus pulmonary syndrome, mediastinitis, fulminate mediastinal tumors pneumonia, gastroenteritis, meningitis, ecthyma, rat bite fever, spider bite, leprosy, plague, tularemia, coccidioidomycosis, diphtheria, glanders, histoplasmosis, psittacosis, typhoid fever, and rickettsial pox. 

Suggested Alternatives for Differential Diagnosis Blastomycosis, coccidioidomycosis, aspergillosis, pneumonia, respiratory distress syndrome, mediastinal cysts, mycoplasma infections, Pancoast syndrome, sarcoidosis, tuberculosis, lung abscess, lung cancer, lymphoma. 

Mediastinal granulomas Severe diffuse pulmonary disease... 

Fibrosing mediastinitis The benefit of antifungal therapy (itraconazole 200 mg twice daily x 3 months) is controversial but should be considered,... 

Vancomycin use may be justified in hospitals with a high incidence of SSI with MRSA or when sternal wounds are to be explored for possible mediastinitis. 

Most patients with HL present with a painless, rubbery lymph node. Adenopathy is usually localized to the cervical region but can also occur in the mediastinal, hilar, and retroperitoneal regions. 

Diagnosis Clinical diagnosis. Physical findings are usually non-specific. Chest X-ray may reveal a pneumonic process, mediastinal lymphadenopathy or plural effusion. Routine culture is possible but difficult. The diagnosis can be established retrospectively by serology. As for treatment, administration of antibiotics such as streptomycin or gentamicin with early treatment can be very effective. 

Mesenteric adenopathy on computed tomography (CT) scan likely. Mediastinal widening on chest X-ray has been reported. 

After intratracheal instillation of nickel chloride or nickel sulphate in rats, a modest inflammatory response with increased number of macrophages and polynuclear leucocytes was obtained, together with increased activities of lactate dehydrogenase and -glucuronidase in bronchoalveolar fluid [351]. More severe lesions were characterized by type II cell hyperplasia with epithelialization of alveoli, and in some animals, fibroplasia of the pulmonary interstitium. By inhalation in rats, the nickel salts produced chronic inflammation and degeneration of the bronchiolar epithelium [352, 353]. There was also atrophy of the olfactory epithelium and hyperplasia of the bronchial and mediastinal lymph nodes. Nickel sulphate also produced a low incidence of emphysema and fibrosis [353]. 

Testes with epididymides3 Thymus and mediastinal contents3 Thyroid with parathyroid3 Trachea... 

Symptoms of the acute phase are acute respiratory distress, breathing difficulty, profuse sweating, turning bluish in color, high temperature, and increased pulse and respiratory rate with chest sounds. If an x-ray is performed, mediastinal widening (swelling of lymph nodes under the breastbone) is very characteristic. Shock and death usually follow within 24 to 36 hours after the onset of respiratory distress. The fatality rate from inhalation anthrax ranges from 65 to 90% even with antibiotic therapy.3... 

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