Diseases of Mediastinum, Chest Wall and Diaphragm

Diseases of Mediastinum

The mediastinum is the central chest compartment between the lungs that contains the heart, esophagus, trachea, thymus, major vessels, and lymph nodes. Diseases may be congenital, infectious, inflammatory, or tumorous.

Common Conditions:

  • Mediastinal tumors: Thymoma, lymphoma, germ cell tumors, neurogenic tumors
  • Mediastinal cysts: Bronchogenic, pericardial, enteric
  • Mediastinitis: Infection/inflammation (e.g. after surgery)
  • Lymphadenopathy: Enlarged lymph nodes due to TB, cancer, sarcoidosis

Diseases of Chest Wall

The chest wall includes ribs, muscles, cartilage, and skin. Diseases can be due to trauma, infections, tumors, or congenital deformities.

Common Conditions:

  • Tumors (benign: lipoma, malignant: sarcoma)
  • Costochondritis / Tietze syndrome
  • Rib fractures
  • Chest wall TB
  • Pectus excavatum/carinatum

Diseases of Diaphragm

The diaphragm is the main respiratory muscle. Its disorders can impair breathing and organ function.

Common Conditions:

  • Diaphragmatic paralysis or eventration
  • Hiatal hernia
  • Diaphragmatic rupture (post trauma)
  • Diaphragmatic tumors (rare)

Mediastinum

Chest Wall

Diaphragm
Symptoms

  • Chest pain
  • Breathlessness
  • Cough
  • Hoarseness (nerve involvement)
  • Swelling of face/neck (SVC syndrome)
  • Difficulty swallowing
 Symptoms

  • Localized pain
  • Visible swelling or mass
  • Restricted chest movement
  • Deformity (sunken or protruded chest)
 Symptoms

  • Shortness of breath (esp. lying flat)
  • Abdominal discomfort
  • Chest pain
  • Reflux symptoms (in hiatal hernia)
  • Recurrent respiratory infections
Causes

  • Tumors (benign or malignant)
  • Infections (TB, fungal, post-surgical)
  • Congenital cysts
  • Autoimmune or inflammatory diseases
 Causes

  • Injury/trauma
  • Infection (TB, osteomyelitis)
  • Bone tumors
  • Inflammatory disorders
  • Congenital deformities
 Causes

  • Nerve injury (phrenic nerve)
  • Trauma
  • Neurological disorders
  • Congenital conditions
  • Tumors or infections
Diagnosis

  • Chest X-ray
  • Contrast-enhanced CT chest
  • MRI (for soft tissue detail)
  • PET-CT (for malignancy)
  • Biopsy via EBUS, mediastinoscopy
 Diagnosis

  • Physical exam
  • Chest X-ray
  • CT scan of chest wall
  • Bone scan or MRI
  • Biopsy if tumor suspected
 Diagnosis

  • Chest X-ray (elevated diaphragm)
  • Fluoroscopy (“sniff test”)
  • CT/MRI for anatomy
  • Diaphragm ultrasound
  • Pulmonary function test (PFT)
Treatment

  • Benign masses: Surgical removal
  • Malignant tumors: Chemotherapy/radiotherapy/surgery
  • Infections (mediastinitis): IV antibiotics
  • Cysts: Surgical excision if symptomatic
 Treatment

  • Pain relief (NSAIDs)
  • Antibiotics for infection
  • Surgical correction (for deformities)
  • Rib fixation (in severe fractures)
  • Physiotherapy
 Treatment

  • Observation if mild/asymptomatic
  • Treat underlying cause (e.g. stroke, infection)
  • Diaphragmatic plication (surgery for paralysis)
  • Repair of hernia or rupture
  • Tumor excision

Frequently Asked Questions (FAQs)

Yes, some mediastinal masses, like lymphomas or thymic tumors can be malignant and may require chemotherapy, radiotherapy or surgery.

No, treatment depends on the cause, some may need only observation, others biopsy or medical therapy, and some surgical removal.

Small ones need lifestyle changes and acid – reducing drugs. Larger or symptomatic ones may need surgical repair.

Yes, it usually follows trauma and can cause abdominal organs to herniate into the chest, needing urgent surgical correction.

Yes, pain from Costochondritis or rib issues may feel similar but lacks other cardiac symptoms. Proper evaluation is crucial.

Through imaging (CT/MRI) followed by a biopsy to determine if they’re benign or malignant.

Only in moderate to severe cases that affect breathing or cause psychological distress. Mild cases may not need surgery.

Yes, chest wall TB can cause abscesses or chronic draining sinuses, requiring anti – TB treatment and sometimes surgical drainage.

It often causes breathlessness, especially while lying down. Some patients remain symptom – free and don’t need treatment.

It’s an abnormal elevation of a weakened diaphragm, which may mimic paralysis but is structurally intact.

Small ones need lifestyle changes and acid reducing drugs. Larger or symptomatic ones may need surgical repair.

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