Mediastinal tumors--problems in diagnosis and treatment.

The cases of 64 patients with a mediastinal tumor have been reviewed. A systemic routine for evaluation of these lesions has evolved, based on their characteristic configuration as well as their predilections for certain sites in the mediastinum. The posteroanterior and lateral megavolt chest x-ray film will allow localization of the lesion in one of the three mediastinal compartments and an impression as to the pathologic process involved. Fifty-five per cent of the lesions were found in the anterior mediastinum, and were further evaluated by laminagraphy. Thirty-one per cent were in the middle mediastinum, where bronchoscopy, nodal biopsy, and skin tests were of value. Fourteen per cent were found in the posterior mediastinum, where laminagraphy and selective angiography were most helpful. Sixty-three per cent of the patients came to operation, while in the remainder a tissue diagnosis was obtained by other means. Fifty per cent of all lesions were malignant. Several case histories are presented to illustrate both interesting and difficult diagnostic problems.