Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
For Mediastinal Masses Differential Workup, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as CXR (Infection/edema/PTX), ABG/VBG (Oxygenation/ventilation), CT chest (indicated) (PE/other). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include SABA, SAMA, Systemic steroids, Antibiotics (if indicated). Use validated frameworks (e.g., Differential by Compartment (Examples)) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Management Notes
Airway compression risk with large masses—plan intubation strategies carefully if needed.
Epidemiology / Risk Factors
- Smoking/chronic lung disease; infections or immobility (VTE)
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CXR | Infection/edema/PTX | Consolidation/effusion/PTX | |
| ABG/VBG | Oxygenation/ventilation | Hypoxemia/hypercapnia | |
| CT chest (indicated) | PE/other | Findings vary |
Differential by Compartment (Examples)
| Compartment | Common Entities |
|---|---|
| Anterior | Thymoma, lymphoma, germ cell, thyroid |
| Middle | Nodes, bronchogenic cyst, vascular |
| Posterior | Neurogenic tumors, esophageal lesions |
| Any | Metastases |
| Key imaging | CT contrast; MRI for neural/vascular |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetaminophen | Analgesic/antipyretic | Hours | Symptom control as appropriate | Hepatotoxicity (overdose) |
| Ondansetron | 5-HT3 antagonism | Minutes | Antiemesis if needed | QT prolongation |
Prognosis / Complications
- Depends on severity/oxygenation; respiratory failure risk
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
References
- Thoracic Surgery/Chest References — Link