Fri, 15 Dec 2023

Myasthenia Gravis

Myasthenia Gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. People with myasthenia gravis may feel the weakness of the arms and legs, and can also have double vision and difficulty speaking or swallowing due to the weakness of the facial muscles. It generally is seen in young ladies. The removal of the Thymus gland helps over 85% of Myasthenia Gravis Patients.

Our team performed Indias first VATS (key-hole) Thymectomy in the year 2000 at AIIMS and also Indias first Robotic Thymectomy at AIIMS in the year 2008. We performed the First Robotic Thymectomy at Sir Ganga Ram Hospital on 16th March 2012 and now, offer these services routinely at Medanta Hospital.


Thymoma is a tumor originating from the thymus gland. It is an uncommon tumor, best known for its association with Myasthenia Gravis. Thymoma is found in 15% of patients with myasthenia gravis. Once diagnosed, the best treatment for thymomas is complete surgical removal. Our team has Indias largest experience in the removal of Thymomas by Robotic Surgery, VATS, or Open surgery (depending upon the tumor size and invasion of surrounding organs).

We have also developed a unique expertise of excising thymomas which involve the superior vena cava. The same is reconstructed with an artificial graft. We are the only center in the country performing this procedure and we have long-term survivors even in these very advanced tumors.


Mediastinal cysts are relatively common in infants and children. Although cysts of the mediastinum are often asymptomatic, once diagnosed, they should be excised completely otherwise they tend to grow over a period o time and create complications. When symptomatic, they cause chest pain, cough, breathing problems, bloody cough or bloody vomiting, and difficulty swallowing. We routinely remove these by VATS/Robotic method.

Posterior Mediastinal Tumour

Posterior Mediastinal tumors are benign or cancerous growths that form in the back area of the chest that separates the lungs. This area, called the posterior mediastinum, is surrounded by the spine in back and the lungs on each side. These tumors can develop at any age although 30-50years is the commonest affected age group. Many a times, they produce no symptom and are incidentally detected on a chest X-ray done for some other reason including, routine medical check-up.

Sometimes, they may cause cough, shortness of breath, chest pain or unexplained weight loss. The diagnosis is confirmed by a CT Scan of the chest. Complete surgical removal is the treatment, best done by VATS/Robotic method which has been our speciality for over a decade.

Mediastinal Lymph Nodes (glands)

Mediastinal Lymph nodes are glands in the middle of the chest. They are quite common in our country, seen at all age from young to elderly. The commonest cause is tuberculosis, however, Lymphoma (a form of cancer of glands), Sarcoidosis, Fungal infection, spread of Tumor from other organs and numerous other causes may be responsible for the enlarged glands. Patients can present with symptoms ranging from fever, weight-loss, weakness, cough, breathlessness to blood in sputum or difficulty in swallowing. Diagnosis is suspected on chest X-ray and confirmed by CT Scan. However, CT Scan can only tell about the location and the size of the gland. The exact cause of enlargement of the gland can only be known by a biopsy of the gland. Although it is a common practise in our country to start these patients on anti-tubercular treatment, in todays era of evidence based medicine, it is preferable to get tissue diagnosis and then start the treatment. Tissue is also required in tuberculosis cases when the disease does not respond adequately to the treatment and resistant tuberculosis is suspected. In such cases, tissue is taken and sent for culture and sensitivity, to be able to start the patient confidently on second line anti-tubercular drugs (which are expensive and toxic).

We can provide an adequate size piece of mediastinal gland by key-hole procedure i.e. Cervical Mediastinoscopy (done through a small incision in the neck) or Thoracoscopy (done through a small incision in the chest), depending on the location of the enlarged gland. These procedures are safe and provide a large piece of tissue, adequate enough for sending for diagnosis as well as culture and other tests.


Q. Can you explain the connection between Thymoma and the Mediastinum?

Thymoma is a rare tumour in the thymus gland which is present within the Mediastinum. The behaviour of the tumour can vary, meaning it can either be benign or malignant. If you are suffering from Thymoma, experiencing symptoms such as chest pain, coughing, or difficulty swallowing is common. Surgical removal is often the primary treatment, and in some cases, additional therapies like radiation or chemotherapy may be recommended based on the tumours characteristics.

Q. Can conditions affecting the Mediastinum be hereditary, and are there preventive measures?

While some conditions, like thymomas, may have a genetic component, most Mediastinal diseases are not directly hereditary. If you have a family history of autoimmune disorders, getting regular health screening once or twice a year can aid in early detection. Some effective preventative measures may include lifestyle choices that support overall health and prompt medical attention for any unusual symptoms or discomfort in the chest area.

Q. Can lifestyle choices influence the risk of developing Mediastinal conditions?

While not all conditions affecting the Mediastinum are directly linked to lifestyle, certain factors, such as smoking or exposure to environmental toxins, can contribute to the development of diseases like Thymoma or lung-related issues. This is one of the reasons why adopting a healthy lifestyle, including regular exercise and avoiding harmful habits, is encouraged.

Q. How does stress impact conditions related to the Mediastinum?

Stress has direct impacts on the immune system and overall health. While it may not directly cause Mediastinal diseases, chronic stress can exacerbate symptoms and potentially contribute to the progression of certain conditions. Effective stress management techniques, such as mindfulness and relaxation exercises, can support managing Mediastinal health.

Q. How does age impact the prevalence of Mediastinal conditions?

Certain conditions, such as Thymoma, may have varying prevalence rates across different age groups. Understanding age-related trends can aid in early detection and timely intervention. Regular health screenings become especially important as individuals age, allowing for the prompt identification and management of potential Mediastinal issues.

Q. How does the Mediastinum contribute to respiratory function, and what happens when it is affected?

The Mediastinum houses critical structures like the trachea and major bronchi, playing a pivotal role in respiratory function. Conditions such as tumours or cysts in this region can compromise airway integrity, leading to breathing difficulties. Understanding the anatomical significance of the Mediastinum underscores the importance of prompt medical attention for any respiratory symptoms, ensuring early intervention and effective management.

Q. Can physical activity worsen or improve symptoms of Mediastinal conditions?

Physical activity can have varied effects depending on the type and severity of the Mediastinal condition. In some cases, moderate exercise may contribute to overall well-being, while strenuous activity might exacerbate symptoms in others. Individuals with Mediastinal conditions must prioritise early consultations for appropriate physical activity levels, ensuring a balance between maintaining fitness and managing their specific health needs.

Q. How do environmental factors contribute to the development of Mediastinal conditions?

Environmental factors, including exposure to certain toxins or pollutants, can contribute to developing conditions affecting the Mediastinum. Understanding these environmental influences is essential for preventive measures and public health initiatives. Advocacy for clean air and awareness of occupational hazards can play a role in reducing the risk of environmentally related Mediastinal conditions.