The mediastinum is the thoracic space between the visceral pleura of the lungs. The boundaries of the mediastinum are the visceral pleura, thoracic inlet (spine, first ribs, and manubrium), diaphragm, sternum, and anterior spinal ligaments. The contents of the mediastinum include the heart, great vessels, trachea, esophagus, thymus gland, lymphatic tissue, and nerves.
Summary
Mediastinal anatomy
Mediastinal contents
Prevascular (anterior) mediastinal contents include:
- Thymus gland
- Mediastinal fat
- Lymph nodes
- Extracardiac aorta.
Visceral (middle) mediastinal contents include:
- Pericardium, heart, ascending and descending aorta, great vessels
- Trachea and carina
- Lymph nodes
- Esophagus
- Vagus nerves
- Thoracic duct.
Paravertebral (posterior) mediastinal contents include:
- Proximal intercostal vessels
- Thoracic spinal ganglion
- Sympathetic nerve chain
- Lymph nodes.
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Anatomic compartments of the mediastinum.
Etiology of mediastinal mass limited by location
Intraoperative view of retrosternal goiter
CT image of large thymic carcinoma (white arrow) with sternal invasion (yellow arrow)
CT image of pericardial cyst
Intraoperative view of pericardial cyst
Necrotic mediastinal lymphadenopathy
Citations
Carter BW, Benveniste MF, Madan R, et al. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017 Mar-Apr;37(2):413-36.[Abstract][Full Text]
Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):7S-37S.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: imaging of mediastinal masses. 2020 [internet publication].[Full Text]
Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):e211S-50S.[Abstract][Full Text]
1. Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014 Sep;9(9 suppl 2):S97-101.[Abstract][Full Text]
2. Carter BW, Benveniste MF, Madan R, et al. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017 Mar-Apr;37(2):413-36.[Abstract][Full Text]
3. Katlic MR, Grillo HC, Wang CA. Substernal goiter: analysis of 80 patients from Massachusetts General Hospital. Am J Surg. 1985;149:283-287.[Abstract]
4. Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg. 2020 Mar;271(3):e21-93.[Abstract]
5. Torre G, Borgonovo G, Amato A, et al. Surgical management of substernal goiter: analysis of 237 patients. Am Surg. 1995;61:826-831.[Abstract]
6. Randolph GW, Shin JJ, Grillo HC, et al. The surgical management of goiter: part II. Surgical treatment and results. Laryngoscope. 2011;121:68-76.[Abstract]
7. Hutchinson CB, Wang E. Primary mediastinal (thymic) large B-cell lymphoma: a short review with brief discussion of mediastinal gray zone lymphoma. Arch Pathol Lab Med. 2011;135:394-398.[Abstract][Full Text]
8. Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment. Circulation. 2008;118:188-195.[Abstract]
9. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73:17-28.[Abstract]
10. Davis RD, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44:229-237.[Abstract]
11. Wright CD. Mediastinal tumors and cysts in the pediatric population. Thorac Surg Clin. 2009;19:47-61.[Abstract]
12. Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer. 2002;94:624-632.[Abstract]
13. Detterbeck FC, Nicholson AG, Kondo K, et al. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011 Jul;6(7 suppl 3):S1710-6.[Full Text]
14. Roden AC, Ahmad U, Cardillo G, et al. Thymic carcinomas-a concise multidisciplinary update on recent developments from the thymic carcinoma working group of the International Thymic Malignancy Interest Group. J Thorac Oncol. 2022 May;17(5):637-50.[Abstract][Full Text]
15. Suster S, Rosai J. Thymic carcinoma: a clinicopathologic study of 60 cases. Cancer. 1991;67:1025-1032.[Abstract]
16. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and association with subsequent malignancies. Int J Cancer. 2003;105:546-551.[Abstract]
17. Marandino L, Vogl UM. Mediastinal germ cell tumours: where we are and where we are going-a narrative review. Mediastinum. 2022 Mar 25:6:7.[Abstract][Full Text]
18. Nichols CR. Mediastinal germ cell tumors: clinical features and biologic correlates. Chest. 1991;99:472-479.[Abstract]
19. Terenziani M, D'Angelo P, Inserra A, et al. Mature and immature teratoma: a report from the second Italian pediatric study. Pediatr Blood Cancer. 2015 Jul;62(7):1202-8.[Abstract]
20. Hainsworth JD, Greco FA. Germ cell neoplasms and other malignancies of the mediastinum. Cancer Treat Res. 2001;105:303-325.[Abstract]
21. Moran CA, Suster S, Koss MN. Primary germ cell tumors of the mediastinum: III. Yolk sac tumor, embryonal carcinoma, choriocarcinoma, and combined nonteratomatous germ cell tumors of the mediastinum - a clinicopathologic and immunohistochemical study of 64 cases. Cancer. 1997;80:699-707.[Abstract][Full Text]
22. Luna MA, Valenzuela-Tamariz J. Germ-cell tumors of the mediastinum, postmortem findings. Am J Clin Pathol. 1976;65:450-454.[Abstract]
23. Webb BD, Walsh GL, Roberts DB, et al. Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience. J Am Coll Surg. 2006;202:237-46.[Abstract]
24. Macchiarini P. Primary tracheal tumours. Lancet Oncol. 2006;7:83-91.[Abstract]
25. Ribet ME, Cardot GR. Neurogenic tumors of the thorax. Ann Thorac Surg. 1994;58:1091-1095.[Abstract]
26. Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):7S-37S.[Abstract][Full Text]
27. Remon J, Soria JC, Peters S, et al. Early and locally advanced non-small-cell lung cancer: an update of the ESMO clinical practice guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol. 2021 Dec;32(12):1637-42.
28. Abner A. Approach to the patient who presents with superior vena cava obstruction. Chest. 1993;103(4 Suppl):394S-397S.[Abstract][Full Text]
29. Azizkhan RG, Dudgeon DL, Buck JR, et al. Life-threatening airway obstruction as a complication to the management of mediastinal masses in children. J Pediatr Surg. 1985;20:816-822.[Abstract]
30. Stang MT, Armstrong MJ, Ogilvie JB, et al. Positional dyspnea and tracheal compression as indications for goiter resection. Arch Surg. 2012;147:621-626.[Abstract][Full Text]
31. American College of Radiology. ACR appropriateness criteria: tracheobronchial disease. 2024 [internet publication].[Full Text]
32. Stephens KE Jr, Wood DE. Bronchoscopic management of central airway obstruction. J Thorac Cardiovasc Surg. 2000;119:289-296.[Abstract]
33. Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med. 2004;169:1278-1297.[Abstract][Full Text]
34. Ho RT, Blackmore CC, Bloch RD, et al. Can we rely on mediastinal widening on chest radiography to identify subjects with aortic injury? Emerg Radiol. 2002;9:183-187.[Abstract]
35. Riambau V, Böckler D, Brunkwall J, et al. Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017 Jan;53(1):4-52.[Full Text]
36. Kouchoukos NT, Dougenis D. Surgery of the thoracic aorta. N Engl J Med. 1997;336:1876-1888.[Abstract]
37. Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation. 2022 Dec 13;146(24):e334-482.[Abstract][Full Text]
38. Braverman AC. Acute aortic dissection: clinician update. Circulation. 2010 Jul 13;122(2):184-8.[Full Text]
39. Atkins MD Jr, Black JH 3rd, Cambria RP. Aortic dissection: perspectives in the era of stent-graft repair. J Vasc Surg. 2006 Feb;43 Suppl A:30A-43A.[Full Text]
40. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015 Jul 28;66(4):350-8.[Abstract][Full Text]
41. Rosman HS, Patel S, Borzak S, et al. Quality of history taking in patients with aortic dissection. Chest. 1998;114:793-795.[Abstract][Full Text]
42. Shiga T, Wajima Z, Apfel CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166:1350-1356.[Abstract][Full Text]
43. Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1-9.[Abstract][Full Text]
44. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128:2893-2909.[Abstract][Full Text]
45. Munden RF, Carter BW, Chiles C, et al. Managing incidental findings on thoracic CT: mediastinal and cardiovascular findings. A white paper of the ACR incidental findings committee. J Am Coll Radiol. 2018 Aug;15(8):1087-96.[Abstract]
46. Tormoehlen LM, Pascuzzi RM. Thymoma, myasthenia gravis, and other paraneoplastic syndromes. Hematol Oncol Clin North Am. 2008;22:509-526.[Abstract]
47. Azarow KS, Pearl RH, Zurcher R, et al. Primary mediastinal masses: a comparison of adult and pediatric populations. J Thorac Cardiovasc Surg. 1993;106:67-72.[Abstract]
48. Takeda S, Miyoshi S, Akashi A, et al. Clinical spectrum of primary mediastinal tumors: a comparison of adult and pediatric populations at a single Japanese institution. J Surg Oncol. 2003;83:24-30.[Abstract]
49. American College of Radiology. ACR appropriateness criteria: imaging of mediastinal masses. 2020 [internet publication].[Full Text]
50. Ackman JB, Wu CC. MRI of the thymus. AJR Am J Roentgenol. 2011;197:W15-W20.[Abstract][Full Text]
51. Wahi JE, Safdie FM. Esophageal duplication cysts: a clinical practice review. Mediastinum. 2023 Jan 25:7:1.[Abstract][Full Text]
52. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):e211S-50S.[Abstract][Full Text]
53. American College of Radiology. ACR appropriateness criteria: noninvasive clinical staging of primary lung cancer. 2018 [internet publication].[Full Text]
54. Hofman MS, Lau WF, Hicks RJ. Somatostatin receptor imaging with 68Ga DOTATATE PET/CT: clinical utility, normal patterns, pearls, and pitfalls in interpretation. Radiographics. 2015 Mar-Apr;35(2):500-16.[Abstract]
55. Petranovic M, Gilman MD, Muniappan A, et al. Diagnostic yield of CT-guided percutaneous transthoracic needle biopsy for diagnosis of anterior mediastinal masses. AJR Am J Roentgenol. 2015;205:774-779.[Abstract][Full Text]
56. Yasufuku K, Nakajima T, Fujiwara T, et al. Utility of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal masses of unknown etiology. Ann Thorac Surg. 2011;91:831-836.[Abstract][Full Text]
57. Varela-Lema L, Fernández-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J. 2009;33:1156-1164.[Abstract]
58. Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA. 2010;304:2245-2252.[Abstract][Full Text]
59. Klijian AS, Gibbs M, Andonian NT. AVATS: awake video assisted thoracic surgery-extended series report. J Cardiothorac Surg. 2014 Aug 28;9:149.[Abstract][Full Text]
60. Soder SA, Pollock C, Ferraro P, et al. Post-operative outcomes associated with open versus robotic thymectomy: a propensity matched analysis. Semin Thorac Cardiovasc Surg. 2023 Spring;35(1):189-99.[Abstract]
61. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation. 2005;111:816-28.[Abstract][Full Text]
62. Eichenauer DA, Aleman BMP, André M, et al. Hodgkin lymphoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(suppl 4):iv19-29.
63. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hodgkin lymphoma [internet publication].[Full Text]
64. Ribet ME, Copin MC, Gosselin B. Bronchogenic cysts of the mediastinum. J Thorac Cardiovasc Surg. 1995;109:1003-1010.[Abstract]
65. Howard FM, Lennon VA, Finley J, et al. Clinical correlations of antibodies that bind, block, or modulate human acetylcholine receptors in myasthenia gravis. Ann N Y Acad Sci. 1987;505:526-538.[Abstract]
66. Morgenthaler TI, Brown LR, Colby TV, et al. Thymoma. Mayo Clin Proc. 1993;68:1110-1123.[Abstract]
