Approach to the prevascular mass

Noriyuki Tomiyama


A wide variety of lesions can manifest as a localized tumor or mass in the anterior mediastinum. The radiological evaluation of these patients begins with chest radiograph and is followed by CT or MRI. CT and MR imaging allow visualization of the exact location of the lesions. The International Thymic Malignancy Interest Group (ITMIG) has introduced a new definition of mediastinal compartments to be used with cross-sectional imaging and adopted as a new standard. This clinical classification defines a 3-compartment model of prevascular (anterior), a visceral (middle), and a paravertebral (posterior) compartment, with anatomic boundaries defined clearly by computed tomography. The most common masses in the prevascular compartment include thymic abnormalities (cysts, hyperplasia, thymoma, thymic carcinoma, and neuroendocrine tumors), germ cell neoplasms, and lymphoma. Metastatic lymphadenopathy and intrathoracic goiter are sometimes seen.