Fig. 21.

Three-year-old boy with a large posterior mediastinal malignant nerve sheath tumour causing marked hypertension due to descending thoracic aortic compression. a Axial T2-weighted MRI image showing severe narrowing of the descending thoracic aorta (solid arrow) and anterior displacement of the IVC (dashed arrow). Sagittal post-contrast T1 images highlight the descending thoracic aortic (b) and upper abdominal IVC (c) compression, respectively. Due to the extensive nature of the mass, surgical resection was not through to be appropriate. The patient has subsequently undergone several cycles of chemotherapy and balloon dilatation of the thoracic aorta accompanied by a slow, but gradual improvement in symptoms and size of tumour