Multiple nodular lesions of mediastinum
Mediastinal inflammation, hematoma, abscess, paratracheal lymph node nuclei, tumors and cysts in mediastinum, dilatation of superior vena cava and azygos vein, aneurysm in mediastinum and pleural effusion can widen the shadow of mediastinum. Combined with clinical and medical history, tomography and angiography should be done when necessary to determine the cause of widening.
However, when the pressure on one side of the chest increases, such as a large number of pleural effusion or tension pneumothorax, emphysema or huge space-occupying lesions on one side can push the mediastinum to shift to the healthy side. On the contrary, when the pressure in one chest cavity decreases or fibrosis changes and contracts, such as atelectasis, pleural thickening and a large number of fibrosis changes in the lungs, the mediastinum is pulled to shift to the affected side. When the bronchus is partially blocked, the mediastinum can swing left and right when breathing (the mediastinum moves to the healthy side when exhaling and the affected side when inhaling) due to the imbalance of chest pressure on both sides during breathing.
Second, mediastinal tumor.
Mediastinal tumors can be divided into primary and metastatic. Metastatic tumors are common, mostly mediastinal lymph node metastasis, and hematogenous metastasis is very rare. There are many kinds of primary mediastinal tumors, which usually include tumors and cysts produced by various tissue structures located in the mediastinum. They often change from mass diseases to the same manifestations as them. Many tumors lack characteristic manifestations and are difficult to distinguish. Common primary mediastinal tumors generally have their predilection sites. According to the location and morphology of the tumor, it is of certain significance for diagnosis, and the type of the tumor can often be inferred (Figure 3-33). According to the shape and density of tumors, benign and malignant manifestations can be roughly distinguished. Lobules and irregular edges are often malignant manifestations. Most circular or elliptical shadows with clear, smooth edges and uniform density are benign. Teratoid tumors have uneven density and include bones or teeth. Arc or ring calcification along the edge of the mass indicates that the mass is cystic or solid tumor has tumor degeneration. Paying attention to the relationship between tumor and surrounding organs is of great significance for studying the location and source of tumor. Tumors originating from thyroid gland can move up and down with swallowing; Tumors near the trachea often compress the trachea, making it narrow and displaced. There may be a well-defined compressive bone defect near the bone of the tumor, which is the manifestation of benign tumor, and erosive bone destruction is the symbol of malignant tumor.