MEDIASTINUM

by Anggreiny or Anggi
Departemen/SMF Radiologi
FK Unpad-RSUP dr.Hasan Sadikin
Mediastinal Anatomy


Includes structures bound
by:
the thoracic inlet
diaphragm
sternum
vertebral bodies
and pleura

Has 3 compartments
Anterior
Middle
Posterior
DIVISIONS OF MEDIASTINUM
Diafragma
Mediastinal Anatomy
Anterior Compartment
includes:
Thymus
Extrapericardial aorta and its
branches
The great veins
Lymphatic tissue.
Middle Compartment is bounded by:
The pericardium anteriorly
The posterior pericardial reflection
The diaphragm
The thoracic inlet.
This compartment includes the heart,
intrapericardial great vessels,
pericardium, and trachea.
Extends from the posterior pericardial reflection to the posterior
border of the vertebral bodies and from the first rib to the
diaphragm.

It includes the esophagus, vagus nerves, thoracic duct, sympathetic
chain, and azygous venous system
Posterior Compartment:
The differential diagnosis of a mediastinal mass depends upon the anatomic compartment in which it arises.
Redrawn from Baue, AE, et al. Glenn's Thoracic and Cardiovascular Surgery. 5th ed. Appleton & Lange,
Norwalk, CT, 1991.
Evaluation: Imaging
2 view PA/Lat Chest X-ray
comparisons with old x-rays important
Chest CT with contrast
most important method of evaluation
Can help determine location, morphology, size, and attenutation coefficient
Important for directing further therapy
MRI
when contrast allergy or renal failure present
when vascular or chest wall involvement is suspected
neurogenic tumors (especially helpful in detecting intraspinal component
Ultrasound
Differentiate cystic from solid masses and relate to surrounding structures
When mass is close to heart or pericardium
Transesophageal or transbronchial useful to evaluate lymph nodes, sometimes for biopsy
Radio nucleotide scanning
With radioactive iodine when thyroid tumor suspected
PET scanning
Can localize specific tumors (pheochromocytoma, paragangliomas, neuroblastomas,
neurogangliomas by targeting their metabolic pathways
Anatomic Distribution of Masses
Anterior Mediastinum
Thymic tumors and cysts
Germ cell tumors
Lymphomas
Intrathoracic goiter and
thyroid tumors
Parathyroid adenomas
Connective tissue tumors
- lipomas and liposarcomas
- lymphangiomas
- hemangiomas

Thymoma
Anatomic Distribution of Masses

Middle Mediastinum

Thyroid tumor or goiter
Tracheal tumors
Aortopulmonary
paraganglioma
paracardial cysts
bronchogenic cysts
lymphoma
Lymphadenopathy
Retrosternal Goiter
Anatomic Distribution of Masses

Posterior Mediastinum
Neurogenic tumors
including Schwannomas
Esophageal tumors
Hiatal Hernias
Neurenteric Cysts
And rarely
extramedullary
hematopoiesis
pancreatic pseudocyst
achalasia
Paraspinal Ganglioneuroma