Key Points

• The majority of mediastinal masses in children are symptomatic. Respiratory involvement is common, due to compression on the small, compliant airway structures.
• Chest radiography and computed tomography (CT) are the diagnostic modalities of choice, while magnetic resonance imaging (MRI) is helpful for tumors of neurogenic origin or those located in the posterior mediastinum.
• Biopsy or resection of most pediatric mediastinal tumors is required.

In the hands of an experienced surgeon, video-assisted thoracoscopic surgery (VATS) plays a major role in the biopsy and resection of mediastinal masses, and is now a preferred approach at many centers.