Mediastinal Syndrome: Diverse Manifestations, Latent Dangers

Mediastinal syndrome is a condition where a tumor or other lesions develop in the mediastinum, compressing surrounding structures such as the trachea, esophagus, nerves, and blood vessels, leading to numerous serious symptoms.

Clinical Manifestations:

• Tracheal Compression:

• Dyspnea: Difficulty breathing with wheezing, supraclavicular and substernal retractions, more prominent when lying down.

• Cough: Dry cough, paroxysmal, possibly with hemoptysis.

• Chest Pain: Depending on the location of compression, constant pain, radiating along intercostal nerves, up to the neck and both arms.

• Esophageal Compression:

• Dysphagia, odynophagia.

• Posterior chest pain, radiating to the side or upward.

• Nerve Compression:

• Recurrent Laryngeal Nerve: Hoarseness, diplophonia, loss of voice.

• Cervical Sympathetic Ganglion: Ptosis, flushing, sunken eyes, narrow palpebral fissures, miosis.

• Brachial Plexus: Pain radiating to the shoulder and inner arm.

• Phrenic Nerve: Hiccups, diaphragmatic muscle pain, dyspnea due to diaphragmatic paralysis.

• Vagus Nerve: Tachycardia, palpitations, chest tightness.

• Systemic Symptoms:

• Weakness.

• Paraneoplastic syndrome.

• Superior Vena Cava Syndrome Leading to Cerebral Venous Congestion:

• Headache, sleep disturbance.

• Facial cyanosis, more severe in the upper half, exacerbated by exertion.

• “Shirt-sleeve” edema.

• Jugular vein distension, collateral circulation.

• Inferior Vena Cava Syndrome:

• Abdominal and chest collateral circulation.

• Hepatomegaly, lower limb edema.

• Subclavian Artery Compression:

• Unequal pulses in both arms, unequal blood pressure in both arms.

• Pulmonary Artery Compression:

• Dyspnea on exertion, systolic ejection click (S2) at the right sternal border.

Diagnostic Tests:

• Chest X-ray:

• PA view: Mediastinal tumor.

• Homogeneous opacity, well-defined margins.

• Outer margin concave toward the lung.

• Mediastinal angle obtuse.

• Image of displacement of the heart, trachea, and vessels.

• Lateral view:

• Tumor location.

• Image of esophageal displacement.

Mediastinal syndrome is a dangerous disease that requires timely diagnosis and treatment.