Philadelphia, PA: Elsevier Saunders; chap McCool FD. Diseases of the diaphragm, chest wall, pleura, and mediastinum. Goldman-Cecil Medicine.
Philadelphia, PA: Elsevier; chap Review provided by VeriMed Healthcare Network. Editorial team. Mediastinal tumor. The mediastinum is divided into three sections: Anterior front Middle Posterior back Mediastinal tumors are rare.
Symptoms that do occur are due to pressure on compression of local structures and may include: Chest pain Fever and chills Cough Coughing up blood hemoptysis Hoarseness Night sweats Shortness of breath.
Exams and Tests. A medical history and physical examination may show: Fever High-pitched breathing sound stridor Swollen or tender lymph nodes lymphadenopathy Unintentional weight loss Wheezing Further tests that may be done include: Chest x-ray CT-guided needle biopsy CT scan of the chest Mediastinoscopy with biopsy MRI of the chest.
Treatment for mediastinal tumors depends on the type of tumor and symptoms: Thymic cancers are treated with surgery. It may be followed by radiation or chemotherapy, depending on the stage of the tumor and the success of the surgery. Thymomas Lymphomas. Anterior : body of the sternum and transversus thoracis muscles Posterior : pericardium. Remnants of the thymus postpubertal Connective tissue and fat. Internal thoracic vessels Lymphatics and parasternal lymph nodes.
Thymomas most common anterior mediastinal mass in children Lymphomas Germ cell tumors e. Anterior and posterior pericardium Between the two pleural cavities. Heart and pericardium Tracheal bifurcation and the left and right main bronchi. Root of the aorta Pulmonary trunk Pericardiacophrenic artery Superior and inferior vena cava Arch of the azygos vein Pulmonary veins.
Phrenic nerve. Anterior : fibrous pericardium and posterior sloping surface of diaphragm Posterior : the bodies of the vertebral column from the lower border of the 5 th —12 th thoracic vertebra. Thoracic portion of the aorta Azygos vein , hemiazygos vein , and thoracic duct. Vagus nerve Sympathetic trunk Splanchnic nerves.
Originates from the aortic orifice from the left ventricle Courses within the pericardium Ends at the level of the angle of Louis. Middle mediastinum : posterior to the sternum. At the level of the aortic valve Left coronary artery Right coronary artery.
Continuation of the ascending aorta Arches superiorly, posteriorly, and to the left before moving inferiorly Connected to the pulmonary trunk by the ligamentum arteriosum Aortic isthmus : narrowing at the final section of the aortic arch , just distal to the origin of the left subclavian artery at the insertion site of the ligamentum arteriosum former ductus arteriosum Forms the aortic knob on chest x-ray.
Superior mediastinum. Brachiocephalic trunk which then splits into right subclavian artery and right common carotid artery Left common carotid artery Left subclavian artery. Continuation of the arch of the aorta Begins at the level of T4 Leaves the thorax via the aortic hiatus in the diaphragm at the level of T12, where it becomes the abdominal aorta. Posterior mediastinum Left side of the thoracic vertebral column and behind the esophagus at its origin Midline of the thoracic vertebral column at its passage through the aortic hiatus.
Bronchial arteries Mediastinal arteries Esophageal arteries Pericardial arteries Superior phrenic arteries Posterior intercostal arteries 9 pairs Subcostal arteries. Formed by the junction between the left and right brachiocephalic veins.
Mediastinal veins Esophageal veins Pericardial veins. Formed by the convergence of the jugular vein and the subclavian vein at the venous angle. Receive blood from the chest wall , neck, esophagus , lungs , and pericardium The right brachiocephalic vein is short and is more vertically oriented, while the left brachiocephalic vein is long and has more horizontal orientation.
Vertebral veins Internal thoracic veins Inferior thyroid veins. Formed by the right subcostal and ascending lumbar veins. Courses along the right side of the thoracic vertebral column Unpaired vein that drains into superior vena cava Enters the thorax via the aortic hiatus of the diaphragm Connected to the inferior vena cava IVC inferiorly.
Hemiazygos vein Bronchial veins Pericardial veins Esophageal veins Right posterior intercostal veins run along the undersurface of the corresponding rib. Formed by the ascending lumbar and left subcostal veins. Courses along the left side of the vertebral column and passes behind the aorta Unpaired vein that drains into the azygos vein Enters the thorax via aortic hiatus or the left crus of the diaphragm Connected to the left renal vein inferiorly.
Formed by the 4 th to 8 th left posterior intercostal veins. Unpaired vein that usually drains into the azygos vein at the level T8 Located on the left side of the vertebral column. Lines the inner surface of the thoracic wall and the mediastinum Divided into the following parts Cervical projects above the first cervical rib into the neck Mediastinal Costal Diaphragmatic.
Moore, Arthur F. Dalley, A. Clinically Oriented Anatomy. Reconciliation of the anatomic, surgical, and radiographic classifications of the mediastinum. A modern definition of mediastinal compartments. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.
Brett W. Carter, Marcelo F. Benveniste, Rachna Madan, Myrna C. Godoy, Patricia M. Truong, Melissa L. Rosado-de-Christenson, Edith M. Related articles: Anatomy: Thoracic. Promoted articles advertising. Figure 2: mediastinal compartments Figure 2: mediastinal compartments. Figure 3 Figure 3. Figure 4: Cardiomediastinal anatomy on chest radiography annotated images Figure 4: Cardiomediastinal anatomy on chest radiography annotated images.
Figure 5: Cardiomediastinal anatomy on chest radiography annotated images Figure 5: Cardiomediastinal anatomy on chest radiography annotated images. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
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