It has relations to the trachea which is anterior to the. An anterior mediastinal mass indents the medial aspect of each lung arrowheads. Department of radiology, brigham and womens hospital. Mediastinal masses in particular represent a significant challenge to. Eus particularly provides access to nodes in the lower mediastinum station 7,8 and 9. Anatomy of the thoracic wall, pulmonary cavities, and. It contains thoracic acid and extends to the vertebral column from the sternum in the front. Radiology of mediastinal masses evaluation of the mediastinum is an important part of the interpretation of a chest xray cxr. A malignant teratoma generally appears on ct and mri as a poorly defined, predominantly soft tissue mass, sometimes containing calcification and fat. Computed tomographic ct scans of 11 patients with an azygos lobe were compared with similar scans of age and gendermatched normal controls. Ebus mediastinal staging 1 th2016 duke masters of minimally invasive thoracic surgery sep 1517, 2016. Every compartment of the mediastinum contains many vital organs, vascular and neural structures that are closely related one to another. Areas of the thorax teachmeanatomy making anatomy simple. Percutaneous biopsy of the lung, mediastinum, and pleura.
The applied anatomy of the mediastinal fascia the prolongation of the perivisceral fascia around the bronchi into the lung substance constitutes a highway connecting the lung to the mediastinum. The inferior mediastinum, the space between the transverse thoracic plane and the diaphragm, is further divided into the anterior, middle, and posterior mediastinum. Anatomy of the thorax lungs and mediastinum ct interactive atlas of human anatomy using crosssectional imaging we created an anatomy atlas of the chest and the mediastinum which is an interactive tool for studying the crosssectional anatomy of the normal thorax based on an enhanced multidetector computed tomography with helical. Keywords thorax cardiac anatomy thoracic wall superior mediastinum middle mediastinum anterior mediastinum posterior mediastinum pleura lungs. Computed tomography ct is the imaging modality of choice for further characterization of suspected mediastinal masses because it can define the anatomy and characterize the tissues. The true incidence of primary mediastinal masses is difficult to ascertain. A multidisciplinary group of 45 experts in thoracic surgery, oncology, diagnostic radiology, and pathology was surveyed. In the posterior mediastinum, it lies on the anterior aspect of the bodies of the lower 7 thoracic vertebrae ascends upward and deviates to the left at about t4, t5 or t6 to reach the superior mediastinum and eventually empties into the venous systembetween the azygous and esophagus. The most common causes of an anterior mediastinal mass include the following. Nov 26, 2019 the mediastinum can be thought of as having two regions, the top, and bottom.
Bhanu prakash usmle, fmge and neet pg 44,791 views. The differential diagnosis includes sarcoidosis and lymphoma. The bottom inferior half is divided into three main regions. The inferior mediastinum is further divided into the anterior, middle and posterior mediastinum. Anatomy of the thorax lungs and mediastinum ct interactive atlas of human anatomy using cross sectional imaging antoine micheau, md, denis hoa, md about segmental. Itmig classification of mediastinal compartments and multidisciplinary approach to mediastinal masses1 division of the mediastinum into specific compartments is beneficial for a number of reasons, including generation of a focused differential diagnosis for mediastinal masses identified on imag. Ct anatomy of normal mediastinum made easy slideshare. Correlative anatomy for the mediastinum request pdf. Scan 50 were undertaken in order to better understand normal mediastinal anatomy as displayed by computed tomography. In certain cases, the imaging features of a mediastinal mass allow a specific diagnosis to be made on the basis of imaging findings. It extends from the spine to the sternum and contains many structures including blood vessels, nerves, oesophagus, trachea and heart. Other malignant germcell tumors arising in the anterior mediastinum are seminoma, embryonal cell carcinoma, choriocarcinoma, and endodermal sinus yolk sac tumor. The hilar vessels are seen through this mass, so it does not arise from the hilum and probably will arise from the anterior mediastinum.
In certain cases, the imaging features of a mediastinal mass allow a specific. The goal of this chapter is to provide a complete picture of the thorax and its contents, with detailed anatomy of thoracic structures excluding the heart. The mediastinum communicates cranially with the fascial planes of the neck by way of the thoracic inlet and caudally with the retroperitoneal space through the aortic hiatus. Lss anatomy of the thorax alexandra burkesmith 4 the internal thoracic arteries are branches of the subclavian arteries the thoracic cavity filled laterally by the lungs each lying in its pleural cavity space between the pleural cavities mediastinum o heart lying. The mediastinum is located between the left and right pleura and close to the median sagittal area of the chest. Apr 10, 2020 this anatomical module is about the anatomy of the mediastinum and the sectional anatomy of the thorax. Rehan at the end of the session, the student should able to.
This chapter discusses both common and rare diseases with specific regard to radiologic findings in the mediastinum. Mediastinum anatomy, location, cavity, organs, function. Pdf radiographic features of mediastinal anatomy researchgate. Atrial contraction, then filling with blood against a closed tricuspid valve creates a double pulsation conducted in a retrograde direction into the central veins that can be observed in the internal jugular vein, when patient is positioned at 45 degrees. Computed tomography ct and magnetic resonance imaging mri have improved our ability to detect, define, and characterize these abnormalities. Such a rich content of the mediastinum indicates its significance from the aspect of the anatomy. Mediastinal first image and lung second image windows of a noncontrast ct. Interest in the mediastinum as a separate body region stems from the diversity and importance of the structures it contains and the multiplicity of disease processes by which it can be affected.
The anterior mediastinum does not appear to be involved, as a normal lucency persists anterior to the heart on the lateral xray. Petct in the imaging of mediastinal masses thoracic key. The mediastinum is the giant blind spot of the cxr. In this video the mediastinum has been discussed and its boundaries the division of mediastinum and contents has also been discussed here. A variety of mediastinal reflections can be identified at conventional radiography fig. Mediastinum we address two common mediastinal incidental. The numbered lines on the scout view to the far left correspond to the numbered thumbnail images at the bottom. It is further subdivided into the anterior mediastinum, middle mediastinum and posterior mediastinum. The anterior mediastinum borders contents teachmeanatomy. The thoracic, or chest wall, consists of a skeletal framework, fascia, muscles, and neurovasculature all connected together to form a strong and protective yet flexible cage. These authors noted a sensitivity of ct scanning for diagnosing positive diseased mediastinal lymph nodes of 70. This lower part is subdivided into three regions, all relative to the pericardium the anterior mediastinum being in front of the pericardium, the middle mediastinum contains the pericardium and its contents, and the posterior mediastinum being behind the pericardium. However, radiography is of very limited value in characterizing mediastinal cancers.
Vascular disorders in the mediastinum such as aortic aneurysm comprise the remaining 10 %. Sep 03, 2017 anatomy of coronary arteries blood supply of heart arterial supply of heart. The anterior mediastinum borders making anatomy simple. Identifying axial ct at the superior mediastinum youtube. Mediastinal lines, stripes and interfaces on pa chest. The inferior mediastinum from this level to the diaphragm. Even though this may sound like a boring description of anatomy, understanding the structures that lie in each of these areas is very important in diagnosing medical conditions in this region.
The mediastinum is the region in the chest between the pleural cavities that contains the heart and other thoracic viscera, except the lungs. Understanding the anatomy of the mediastinum and the hilum is. The mediastinum may also be divided into dorsal and ventral portions by a dorsal plane through the tracheal bifurcation. Superior mediastinum schemaofthecrossection sternum rest ofthethymus vrstva zil nerves arteries trachea oesophagus pleuras v. To evaluate masses seen on chest xrays, ct scan of the chest is. The posterior mediastinum or paravertebral compartment is a potential space along the paravertebral sulci. Mediastinum is the space in the chest between the pleural sacs of the lungs. Correlative ct studies of a cadaver and a statistical analysis of all thoracic scans performed in the first year of operation of a deltascan 50 were undertaken in order to better understand normal mediastinal anatomy as. The first step in understanding thorax anatomy is to find out its boundaries. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts. A good diagnostic strategy combines classification of the mass by location, tissue density, and a probabilistic approach. Mip image a, contrastenhanced ct b and fused axial pet ct image c show a heterogeneously contrastenhancing mass in the anterior and middle mediastinum that extends from the thoracic inlet to the lower end of the sternum. The inferior mediastinum itself can be further divided into the anterior, middle and posterior mediastinum, which all lie between the sternal angle and the diaphragm.
The two mediastinal pleural layers are part of the right and left pleural sacs. In a study of more than 9000 patients in a lung cancer ct screening trial, the prevalence of an incidentally detected mediastinal mass was 0. The location and composition of a mass is critical to narrowing the differential diagnosis. Each pleural sac is composed of mediastinal, diaphragmatic, costal and pulmonary pleura.
Note anterior displacement of the trachea by the mass. Lyon percutaneous biopsy of chest lesions is performed for evaluation of focal lung lesions, mediastinal or hilar masses, and pleural or chest wall lesions. Identify the divisions of the mediastinum and describe their contents. The patients workup was consistent with sarcoidosis.
The mediastinum is visible in this dog dissection, left lung removed. Ct scans depicting anatomy at the levels of the aortic arch and carina. A modern definition of mediastinal compartments journal of. On the chest film there is a mass that has obtuse angles with the mediastinum, so it is a mediastinal mass. Anatomy of the thoracic wall, pulmonary cavities, and mediastinum. Abnormalities include benign and malignant neoplasms, cysts, and mediastinal thyroid. Tumors of the mediastinum represent a wide diversity of disease states. Diagnosing and staging lung cancer involving the mediastinum. The majority of middle mediastinal masses will consist of foregut duplication cysts eg oesophageal duplication or bronchogenic cysts or lymphadenopathy. The thorax is the body cavity, surrounded by the bony rib cage, that contains the heart and lungs, the great vessels, the esophagus and trachea, the. The mediastinum from medieval latin mediastinus, midway is the central compartment of the thoracic cavity surrounded by loose connective tissue, as an undelineated region that contains a group of structures within the thorax.
Inferior mediastinum extends downwards, terminating at the diaphragm. Saying that it is important is not the same as saying that it is well done. Dec 26, 2019 anatomy of the thorax lungs and mediastinum ct interactive atlas of human anatomy using crosssectional imaging we created an anatomy atlas of the chest and the mediastinum which is an interactive tool for studying the crosssectional anatomy of the normal thorax based on an enhanced multidetector computed tomography with helical. In this article, we shall look at the anatomy of the anterior mediastinum its borders, contents and clinical correlations. In a disease called myasthenia gravis, 15% of patients have a malignant thymoma. It is further subdivided into four arbitrary portions by the pericardium, namely, superior, anterior, middle, and posterior compartments. It lies in the midline of the chest between the pleura of each lung and extends from the sternum to the vertebral col. Click on one of these thumbnail images to show a larger numbered version of the image to the near left.
It is located between the sternum in front and the vertebral column behind, mediastinal pleura in the side, thoracic. The mediastinum divides the thoracic cage into two halves. Endoscopic ultrasound with fine needle aspiration can be performed of all the mediastinal nodes that that can be assessed from the oesophagus. It is conceptually considered a portion of the inferior mediastinum, and separated from the middle mediastinal compartment and the remainder of the extrapleural intrathoracic cavity by arbitrary lines.
Mediastinum 1 download these slides free of cost from. The superior mediastinum is the area of the thorax above the sternal angle at the level of the t4 vertebra and between the thoracic aperture. The mediastinum is a large anatomic compartment in the thoracic cavity, bounded laterally by the pleurae, anteriorly by the sternum, posteriorly by the vertebrae, superiorly by the thoracic inlet, and inferiorly by the diaphragm. Mediastinum middle space in the thoracic cavity between the lungs 3. The organ serves as a role in the development of t lymphocytes in the immune system. In the anatomical position the internal jugular veins contain little blood and are collapsed flat. The superior mediastinum contains the major vessels supplying the upper extremity, the neck, and the head. Lateral chest radiograph shows the an tenor mass displacing the. The middle mediastinum is the space containing the heart and pericardium.
The mediastinum contains all the thoracic viscera except the lungs. The prevalence of incidental enlarged mediastinal lymph nodes on lung cancer and coronary artery disease screening ct scans is 1. Correlative ct studies of a cadaver and a statistical analysis of all thoracic scans performed in the first year of operation of. The purpose of this article is to provide an update on evidencebased methods for mediastinal staging in patients with lung cancer. Sep 08, 20 mediastinum 1 download these slides free of cost from.
This thoracic anatomy tool is especially useful for students medical and paramedical studies. Nov 22, 20 ct anatomy of normal mediastinum made easy 1. Many focal and diffuse abnormalities occur in the mediastinum. Mediastinum anatomy international journal of anatomy radiology. These are axial views of the chest with emphasis on the mediastinum as seen by computed tomography. In addition the left adrenal gland and the left liver lobe can be visualized. Section of the mediastinum into compartments is used to defining the localisation of mediastinal structures, solution at the. This photo gallery presents the anatomy of the chest by means of ct axial reconstructions mediastinal window.904 366 1109 38 88 567 1076 774 170 1282 522 670 1412 134 353 115 1503 441 357 534 1359 1442 1308 1488 1120 824 752 862 981 409 822 402 1160 784 554 693 522 625 702 699 1439