Surgical management of mediastinal tumors and fibrosis

Mediastinal tumors are uncommon and often asymptomatic if benign. Tumors ha ve a predilection for arising in one of three mediastinal compartments: the anterior, middle, or posterior. If symptoms are present, they are usually compressive in origin. Computed tomography is almost always the imaging mod ality of first choice. Benign-appearing lesions are usually resected for cu re. Malignant-appearing lesions usually require biopsy by the least invasiv e route appropriate for the suspected tumor type. Mediastinal fibrosis is t hought to be caused by Histoplasma capsulatum most commonly and usually pre sents with progressive compressive symptoms, Oral antifungal agents have be en reported to control the disease. Stenting, superior vena caval bypass, a nd resectional surgery are sometimes required to palliate obstructive proce sses.