Abstract

Mediastinal masses encompass a wide range of pathological entities that can arise from various structures within the mediastinum, each with distinct clinical and radiologic characteristics. Accurate differentiation between these masses is critical for guiding appropriate management and improving patient outcomes. This review explores the role of radiologic imaging in the differential diagnosis of mediastinal masses, emphasizing the contributions of chest radiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The mediastinum is anatomically divided into anterior, middle, and posterior compartments, each associated with specific types of masses. Radiologic modalities provide vital insights into the nature, origin, and potential malignancy of these masses, with CT serving as the cornerstone for detailed anatomical assessment, while MRI and PET offer superior soft tissue contrast and metabolic evaluation, respectively. The review discusses the characteristic imaging features of common mediastinal masses, such as thymomas, lymphomas, germ cell tumors, neurogenic tumors, and vascular anomalies, highlighting the importance of a multimodality imaging approach in achieving an accurate diagnosis. Advanced imaging techniques, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI), further enhance tissue characterization, aiding in the distinction between benign and malignant lesions. Radiologic insights are essential not only for differential diagnosis but also for determining the optimal therapeutic strategy, whether it be surgical intervention or conservative management.