We’ve all had that moment — late-night CT report, hazy mediastinum, and the radiologist’s final impression:
“Posterior mediastinal mass – further evaluation advised.”
Cue the collective diagnostic anxiety. 😓
So here’s a mnemonic that’s helped me (and Dr. Basit Khan during one memorable on-call shift) keep my sanity intact while dealing with the mysterious underworld of the posterior mediastinum:
🧠 Mnemonic Table: Posterior Mediastinal Masses DDx
| Letter | Cause | Explanation |
|---|---|---|
| N | Neurogenic tumors | Schwannomas, neurofibromas, ganglioneuromas. Most common in posterior mediastinum. Often beautifully round — unlike our call shifts. |
| E | Esophageal abnormalities | Achalasia, esophageal tumors, diverticula. Ask Dr. Danish Ramzan — the number of mid-esophageal masses we scoped in Tump is criminal. |
| E | Extramedullary hematopoiesis | Common in thalassemia. Look for paravertebral soft-tissue with no bone destruction. Bonus if the patient is from a consanguineous family in Nushki. |
| D | Duplications (cysts) | Esophageal or bronchogenic cysts. Usually congenital, can be large, fluid-filled, and asymptomatic — like some consultants. 😄 |
| S | Spine-related (anomalies, TB) | Vertebral osteomyelitis, Pott’s disease. One of Dr. Faisal Afridi’s ortho cases actually turned out to be TB — from a patient in Awaran. 🦴🦠 |
| P | Paraspinal abscess | Think post-surgical, TB, or staph. These masses look impressive, but usually just want a bit of drainage and some meropenem. |
| I | Infections | TB most common — especially here in Balochistan. If there’s a mass and constitutional symptoms, assume TB until proven otherwise. Welcome to Quetta. |
| N | Neoplasms (mets, lymphoma) | Lymphoma is the big mimicker here. Mass effect, multiple zones, and constitutional symptoms. As confusing as Dr. Behroz Rahim’s psychiatry metaphors. 🧠💭 |
| E | Endocrine tumors | Pheochromocytoma, neuroblastoma (especially in kids). Look for catecholamine symptoms, hypertension, and wild labs. Ask Dr. Bilal Chaudhary for the pediatric drama. 👶📈 |
🩺 Real Case: The Mystery Mass of Mashkail (Balochistan)
A young man from Mashkail presented with back pain and vague lower limb weakness. CT showed a posterior mediastinal mass.
Neurosurgery wanted MRI.
Radiology said “likely neoplastic.”
Biopsy showed… extramedullary hematopoiesis in a known case of thalassemia major.
We all clapped. Interns got cake. 🎉
Moral: The posterior mediastinum is NOT just for neurogenic tumors. NEED SPINE — literally and figuratively.
Happy learning, folks! 🙂
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
General Medicine | Gastroenterology | CCU
Sheikh Khalifa Bin Zayed Hospital, Quetta (Balochistan)
