Mediastinum

X-ray conference 30th March, 2010

Palanan Siriwanarangsan, M.D.

Wheres the lesion? Whats the lesion ?

Scope
Methods of mediastinal division Normal anatomy for each compartment Normal mediastinal reflections How the presence of distortion of these reflections can reveal mediastinal disease

Trachea on CXR
Hilum

Lets look at the normal Mediastinal Structures

Superior Vena Cava Ascending Aorta

Right Atrium Inferior Vena Cava

Vessels Aortic Arch

Pulmonary Artery Left Atrium

Left Ventricle

Aortic Knob/Arch Descending Aorta Left Atrium

Left Ventricle Inferior Vena Cava

Ascending Aorta

Right Ventricle

The differential diagnosis of a mediastinal mass depends upon the anatomic compartment in which it arises. Redrawn from Baue, AE, et al. Glenn's Thoracic and Cardiovascular Surgery. 5th ed. Appleton & Lange, Norwalk, CT, 1991.

Anterior mediastinum

The hilum overlay sign is present when the normal hilar structures project through a mass

Middle mediastinum

A right paratracheal stripe 5 mm or more in width is considered widened

A convex border between the AP window and the lung is considered abnormal

Enlarged azygos vein, may be mistaken for lymphadenopathy

Posterior mediastinum

The azygoesophageal recess reflection is a prevertebral structure and is, therefore, disrupted by prevertebral disease

The paraspinal lines are disrupted by paravertebral diseasewhich commonly includes diseases originating in the intervertebral disks and vertebraeand by neurogenic tumors.

Take home message

Hilum overlay sign Right paratracheal stripe Mediastinum reflections at the AP window Azygoesophageal recess Posterior junction line Paraspinal lines

THANK YOU