Imaging the Mediastinum Flashcards
Can you see the SVC?
no as it’s covered in fatty tissue
Mediastinal Divisions and whats in them?
Anterior: Thymus
Middle: Heart
Posterior: oesophagus, aorta, thoracic duct, Nerves (IC, PS, sympathetic)
Superior: Thyroid
What can commonly go wrong in each division?
Anterior: thyroid, thymoma, lymphoma, teratoma
Middle: cardiac & vascular lesions, oesoph. abnormalitie, lymphadenopathy
Posterior: Neurogenic tumors
Superior: Thyroid (goitre)
What do ALL compartments have?
CT, BVs, nerves etc
What is the azygo-oesophageal recess
Where the right lung interfaces with the mediastinal reflection to the azygos vein. The oesophagus is anterior to the vein.
The air-oesoph interface can be seen on CXR as a line.
Marks middle mediastinum
Main problems
Vascular (aortic dissection or aneurysm) Trauma (line placement) Neoplasms (benign or malignant) Congenital cysts (brochogenic) Involvement from adjacent structures
Vascular Abnormalities
Congenital: aortic arch abnorm.
Acquired: trauma; aortic dissection, aneurysms or Coronary vessel disease
Trauma
Line Placement: Done by doctors!
Blunt Trauma
Barotrauma: in asthmatics
Oesophageal rupture
Neoplasms in what divisions
Anterior: Thyroid (goitre), thymus, teratoma, lymphoma
Middle: Lymphadenopathy (metastases or lymphoma)
Posterior: Neurogenic tumours
Superior: Goitre
Thyroid tumour comes from
Down from above
Fatter mediastinum could indicate
Lymphadenopathy
Bronchogenic cysts
people can have since childhood (congenital and benign). So surgeons should stay away
Hiatal hernia
Usually asymptomatic comes up from lower part, BUT digestive tract can come up into mediastinum and cause issues, eg; bowel twisting.
Signs of CHF
- Cardiomegaly usually (big heart)
- Vascular redistribution; azygous
- Interstitial; peribronchial thickening
- Pulmonary Oedema
- Pleural Effusions
Neurogenic tumours
90% + masses in posterior mediastinum is NG.
