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Mediastinum

X-ray conference

30th March, 2010

Palanan Siriwanarangsan, M.D.

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Wheres the lesion?

Whats the lesion ?

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Scope

Methods of mediastinal division

Normal anatomy for each compartment

Normal mediastinal reflections

How the presence of distortion of thesereflections can reveal mediastinal disease

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Trachea

on CXR

Lets look at the normal

Mediastinal Structures

Hilum

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Vessels

Aortic Arch

Pulmonary Artery

Left Atrium

Left VentricleInferiorVenaCava

RightAtrium

AscendingAorta

SuperiorVena

Cava

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Descending

Aorta

Aortic

Knob/Arch

Ascending

Aorta

Right

Ventricle

Inferior Vena Cava

LeftVentricle

LeftAtrium

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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.

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Anterior mediastinum

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

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Middle mediastinum

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A right paratracheal stripe 5 mm or more inwidth is considered widened

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A convex border between the AP window

and the lung is considered abnormal

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Enlarged azygos vein, may be mistaken forlymphadenopathy

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Posterior mediastinum

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The azygoesophageal recess reflection is a prevertebralstructure and is, therefore, disrupted by

prevertebral disease

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The paraspinal lines are disrupted by paravertebraldiseasewhich commonly includes diseases

originating in the intervertebral disks andvertebraeand by neurogenic tumors.

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Take home message

Hilum overlay sign

Right paratracheal stripe

Mediastinum reflections at the AP window

Azygoesophageal recess

Posterior junction line

Paraspinal lines

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