Mediastinum

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Mediastinum
Mediastinum.png
Mediastinum. The division between superior and inferior is at the sternal angle.
Mediastinum anatomy.jpg
Mediastinum anatomy
Details
Identifiers
Latin mediastinus
TA A07.1.02.101
FMA 9826
Anatomical terminology

The mediastinum (from Medieval Latin mediastinus, "midway"[1]) 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. The mediastinum contains the heart and its vessels, the esophagus, trachea, phrenic and cardiac nerves, the thoracic duct, thymus and lymph nodes of the central chest.

Structure[edit]

The mediastinum lies within the thorax and is enclosed on the right and left by pleurae. It is surrounded by the chest wall in front, the lungs to the sides and the spine at the back. It extends from the sternum in front to the vertebral column behind, and contains all the organs of the thorax except the lungs. It is continuous with the loose connective tissue of the neck.

The mediastinum can be divided into an upper (or superior) and lower (or inferior) part:

  • The superior mediastinum starts at the superior thoracic aperture and ends at the thoracic plane.
  • The thoracic plane separates the superior and inferior mediastinum. It is a plane at the level of the sternal angle , and the intervertebral disc of T4-T5.[2][3][4]
  • The inferior mediastinum from this level to the diaphragm. 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.

Anatomists, surgeons, and clinical radiologists compartmentalize the mediastinum differently. For instance, in the radiological scheme of Felson, there are only three compartments (anterior, middle, and posterior), and the heart is part of the anterior mediastinum.[5][page needed]

Superior mediastinum[edit]

The superior mediastinum is bounded by:

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Thoracic plane[edit]

A number of structures occur at the level of the thoracic plane, which divides the superior and inferior mediastinum:

Structures at the level of the thoracic plane edit
  1. The start and end of the aortic arch
  2. The division between the superior and inferior mediastinum
  3. The upper margin of the superior vena cava [9]
  4. The crossing of the thoracic duct
  5. The bifurcation of the trachea [10]
  6. The bifurcation of the pulmonary trunk
  7. The level of the sternal angle
  8. The level of Rib 2 where it attaches to the sternum via the 2nd costal cartilage
  9. The body of vertebrae T4 (the disc between the vertebrae T4 and T5)
  10. The drainage of the azygos vein into the superior vena cava
  11. thymus gland(in some cases)

Inferior mediastinum[edit]

Anterior mediastinum

Bounded:

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Middle mediastinum

Bounded: pericardial sac It contains the vital organs and is classified into the serous and fibrous pericardium

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Posterior mediastinum

It is bounded:

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Clinical significance[edit]

Mediastinal adenopathy

The mediastinum is frequently the site of involvement of various tumors:

  • Anterior mediastinum: substernal thyroid goiters, lymphoma, thymoma, and teratoma.
  • Middle mediastinum: lymphadenopathy, metastatic disease such as from small cell carcinoma from the lung.
  • Posterior mediastinum: Neurogenic tumors, either from the nerve sheath (mostly benign) or elsewhere (mostly malignant).

Mediastinitis is inflammation of the tissues in the mediastinum, usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress very quickly, this is a serious condition.

Pneumomediastinum is the presence of air in the mediastinum, which in some cases can lead to pneumothorax, pneumoperitoneum, and pneumopericardium if left untreated. However, that does not always occur and sometimes those conditions are actually the cause, not the result, of pneumomediastinum. These conditions frequently accompany Boerhaave's syndrome, or spontaneous esophageal rupture.

There are many diseases that can present with a widened mediastinum (usually found via a chest x-ray). The most common ones are aortic unfolding, traumatic aortic rupture, thoracic aortic aneurysm, and traumatic thoracic vertebral fracture. A widened mediastinum is a classic but rare hallmark sign of anthrax infection.[citation needed]

See also[edit]

References[edit]

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

External links[edit]