Imaging of paediatric mediastinal abnormalities

Lateral chest X-ray demonstrating the boundaries of the anterior, middle and posterior mediastinum. This is a patient with cystic fibrosis, which accounts for the hyperinflation.

Chest X-ray of a neonate with apparent widening of the mediastinum as a result of the normal thymus. Note the slightly “wavy” left lateral border.

Frontal (a) and lateral (b) chest X-rays of a child with a large anterior mediastinal mass caused by a lymphoma. On the lateral view, where there would normally be aerated lung anterior to the heart and great vessels, the space is filled with soft tissue.

(a) and (b) Enhanced chest computed tomography scans of another child with lymphoma. There is a large anterior mediastinal mass with some lower attenuation cystic components (open arrows). The trachea is compressed and displaced to the right (solid arrow). There are also bilateral pleural effusions and consolidation in the left lower lobe.

(a) and (b) Enhanced chest computed tomography scans showing a large anterior mediastinal mass extending into the left hemithorax and displacing the mediastinum to the right. It is multicystic with a relatively thick wall (arrow) and contains fat – the small areas of very low attenuation (arrowheads). There is also a left-sided pleural effusion. This was a benign teratoma.

Lymphatic malformation. Coronal T2-weighted magnetic resonance imaging scan of the neck and chest showing a multi-loculated high signal intensity lesion in the neck (small arrows) and extending into the superior mediastinum (larger arrow).

(a) Chest X-ray of a 3-year-old child showing a well-defined right paratracheal mass. This was an incidental finding on a chest X-ray taken during a lower respiratory tract infection. (b) Chest computed tomography scan in the same patient showing that the right paratracheal mass is a thin-walled cyst (arrow). There is no associated tracheal abnormality. This was excised and confirmed to be a bronchogenic cyst.

(a) Chest X-ray of a 4-year-old child with stridor showing a well-defined mass in the superior mediastinum that is displacing the trachea to the left. (b) Enhanced chest computed tomography confirms the cystic nature of the mass, which is displacing and narrowing the trachea. This was an oesophageal duplication cyst.

Chest X-ray of a child with a large right-sided mediastinal neurenteric cyst. Note the congenital vertebral anomalies in the lower cervical spine.

(a) Chest X-ray in a child with dysphagia showing a dilated, gas-filled oesophagus (arrowheads) resulting from achalasia. (b) Barium swallow in the same child showing a dilated oesophagus with an air–fluid level and characteristic “beaking” of the distal oesophagus.

Chest X-ray of a child with a right aortic arch.

(a) Barium swallow (frontal view) showing indentation of both sides of the upper oesophagus caused by a double aortic arch. (b) Double aortic arch (arrowheads) on a coronal T1-weighted magnetic resonance imaging scan.

(a) Chest X-ray of a 14-month-old child with neuroblastoma. There are bilateral paravertebral soft tissue masses in the lower chest/upper abdomen. (b) Coronal T2-weighted magnetic resonance imaging scan demonstrating the high signal intensity of both paravertebral tumours (arrows). (c) MIBG scan showing uptake into the paravertebral tumours (arrowheads).

Chest X-ray of an immunocompromised child with Pneumocystis carinii pneumonia. There is pneumomediastinum with elevation of the thymic lobes, giving an “angel wings” appearance to the upper mediastinum.