Widened Superior Mediastinum

CLINICAL DIAGNOSTIC MANUAL

A widened superior mediastinum on a chest X-ray refers to an increased width of the mediastinal space in the upper thorax. This finding can be indicative of various pathologies affecting the anatomical structures within the mediastinum, including lymph nodes, large vessels, glands, and tissues. Accurate evaluation is crucial as it may be associated with both benign and malignant conditions requiring specific intervention.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Goitre	Dysphagia, dyspnoea, palpable neck mass	History of hypothyroidism/hyperthyroidism, neck mass	Chest X-ray, neck and chest CT, thyroid ultrasound, thyroid function tests
Lymphoma	Fever, weight loss, night sweats, generalised lymphadenopathy	History of systemic symptoms and lymphadenopathy	Chest X-ray, chest CT, lymph node biopsy, PET scan
Metastatic lymphadenopathy	Weight loss, dyspnoea, chest pain, history of primary cancer	History of cancer in another site, respiratory symptoms	Chest X-ray, chest CT, lymph node biopsy, PET scan
Thymoma	Dyspnoea, cough, chest pain, myasthenia gravis symptoms	History of neuromuscular symptoms, mediastinal mass	Chest X-ray, chest CT, biopsy, serological tests for myasthenia gravis
Teratoma	Dyspnoea, cough, chest pain, palpable mass	History of respiratory symptoms and mass	Chest X-ray, chest CT, biopsy, tumour markers
Tortuous aorta	Dyspnoea, chest pain, signs of aortic insufficiency	History of Marfan syndrome or connective tissue disorders	Chest X-ray, chest CT or MRI, echocardiography
Aortic aneurysm	Severe chest pain, dyspnoea, syncope, signs of shock	History of cardiovascular risk factors	Chest X-ray, chest CT or MRI, echocardiography, angiography