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Mediastinal Mass on Chest X-ray Abnormal mediastinal contour or widening; localization by compartment is key to diagnosis. Step 1: Localize the Compartment (CXR Clues) Anterior mediastinum \t•\tLoss of normal retrosternal clear space (on lateral view) \t•\tSilhouette sign with heart or ascending aorta \t•\tMass does not move with respiration Middle mediastinum \t•\tWidened mediastinum with preserved retrosternal space \t•\tOften centered around hila, trachea, or carina \t•\tMay show air–fluid le
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