Evaluation of mediastinal mass

Diseases

Summary

Mediastinal anatomy

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. Tumors may arise from any of these structures. The mediastinum is commonly divided into the anterior, middle, and posterior compartments. Occasionally, radiographic or anatomic texts may refer to a superior compartment, which adds little to clinical management.Images

Mediastinal contents

Anterior mediastinal contents include:

Thymus gland
Mediastinal fat
Lymph nodes
Extracardiac aorta.

Middle mediastinal contents include:

Pericardium, heart, ascending and descending aorta, great vessels
Trachea and carina
Lymph nodes
Esophagus
Vagus nerves
Thoracic duct.

Posterior mediastinal contents include:

Proximal intercostal vessels
Thoracic spinal ganglion
Sympathetic nerve chain
Lymph nodes.

Library

Borders of the mediastinum
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

Key Articles

Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128:2893-2909.[Abstract][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(5 Suppl):e211S-e250S.[Abstract][Full Text]
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]
Marom EM, Milito MA, Moran CA, et al. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol. 2011;6:1274-1281.[Abstract]

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