In most clinical situations the modern radiological approach to a medi
astinal mass consists of performing a CT scan following the chest radi
ograph. Magnetic resonance imaging is indicated when CT findings are e
quivocal and as the first-line method in particular situations such as
suspected involvement of the posterior mediastinum. Tn both technique
s, tissular components of the mass assessed by density or signal inten
sity analysis, together with the precise location, are the leading edg
e of the radiological diagnosis. This review deals mainly with the dif
ferential diagnosis of primary neoplasms according to CT and MRT findi
ngs.