From the Guidelines
Airway narrowing in the upper mediastinum is primarily caused by various nonmalignant conditions, including postintubation/tracheostomy-related tracheal stenosis, inflammatory conditions, infections, and mechanical compression by surrounding structures. The causes of airway narrowing in the upper mediastinum can be categorized into several groups, including:
- Nonmalignant central airway obstruction etiologies, such as postintubation/tracheostomy-related tracheal stenosis, idiopathic tracheal or bronchial stenosis, and inflammatory conditions like granulomatosis with polyangiitis, relapsing polychondritis, and radiation-induced stenosis 1
- Infections, including tuberculosis, fungal infections, recurrent respiratory papillomatosis, and rhinoscleroma 1
- Mechanical compression by surrounding structures, such as goiter, aortic aneurysm, and other vascular abnormalities 1
- Other conditions, including lung transplantation-related stenosis and bronchomalacia, expiratory airway collapse, and nonmalignant airway tumors/lesions 1 It is essential to note that the management of central airway obstruction is supported by limited high-quality evidence, and a systematic approach is necessary to address the complexity of these conditions 1.
From the Research
Causes of Airway Narrowing in the Upper Mediastinum
The upper mediastinum is a complex anatomical region that can be affected by various conditions, leading to airway narrowing. Some of the causes of airway narrowing in this region include:
- Mediastinal lymphadenopathy, which can be caused by malignancy (lung cancer, lymphoma, and extrathoracic cancer) and granulomatous conditions (sarcoidosis and tuberculosis) 2
- Mediastinal germ cell tumors, which can cause airway compression or narrowing 3
- Tumors and tumorlike conditions of the large airways, which can be focal or diffuse and can affect the trachea or bronchi 4
- Tumors of the mediastinum, which can be located in the anterior, middle, or posterior mediastinum and can cause airway narrowing or compression 5
- Diseases of the anterior mediastinum, which can include primary tumors (thymoma, teratoma, lymphoma) and nonneoplastic lesions (thymic cysts, lymphangioma, intrathoracic goitre) 6
Specific Conditions Causing Airway Narrowing
Some specific conditions that can cause airway narrowing in the upper mediastinum include:
- Thymoma, which is a type of tumor that can occur in the anterior mediastinum 5, 6
- Teratoma, which is a type of tumor that can occur in the anterior mediastinum 3, 5, 6
- Lymphoma, which is a type of cancer that can occur in the mediastinum 2, 5, 6
- Sarcoidosis, which is a granulomatous condition that can cause mediastinal lymphadenopathy 2
- Tuberculosis, which is a granulomatous condition that can cause mediastinal lymphadenopathy 2