Physical Findings: Patients with mediastinal germ cell tumors have few abnormal physical findings. In patients with large tumors, decreased breath sounds, and dullness on the affected side may be encountered. Tumor extension to the pericardium or throughout the mediastinum can produce pericardial or pleural effusions with associated findings. Superior vena cava syndrome due to vascular compression by rapidly growing tumors occurs in 10 to 20 percent of cases. Occasionally, one finds evidence of extrathoracic disease such as supraclavicular lymph nodes or dissemination to other sites. The presence of retroperitoneal adenopathy or a testicular mass is uncommon and should prompt more thorough evaluation for a testicular primary. buy cheap antibiotics
Roentgenographic Findings: Most mediastinal germ cell tumors arise within the anterior mediastinum, particularly the anterosuperior portion (Fig 1). Only 3 to 8 percent of mediastinal germ cell tumors arise within the posterior mediastinum.’ Other rare sites include the hilum and lung parenchyma. In over 95 percent of cases, the standard posteroanterior and lateral chest roentgenograms are abnormal. Computerized tomographic scans of the thorax provide supplemental information including extent of disease, involvement of adjacent structures and presence of subtle calcifications (Fig 2). The presence of teeth within the mediastinal mass heightens the suspicion of benign teratoma.
Figure 1. Chest roentgenograph in a patient with benign mediastinal teratoma.
Figure 2. Computed tomography of chest in a patient with benign mediastinal teratoma.
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