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Mediastinal anatomy ,classification of mediastinal masses ans its localization
- 2. Mediastinum Mediastinum is median septum of the thorax between the two lungs. Divisons : Mediastinum is divided into a) Superior Mediastinum b) Inferior mediastinum Inferior mediastinum is further divided into the anterior, middle and posterior mediastinum
- 3. * ANATOMISTS DIVIDE MEDIASTINUM INTO 4 PARTS----- SUPERIOR,AND INFERIOR COMPARTMENTS BY AN IMAGINARY LINE TRAVERSING THE MANUBRIOSTERNAL JOINT AND LOWER SURFACE OF 4TH DORSAL VERTEBRA. THE INFERIOR COMPARTMENT IS FURTHER SUBDIVIDED INTO 3 PARTS THE MIDDLE MEDIASTINUM WHICH CONTAINS PERICARDIUM AND ITS CONTENTS,AS WELL AS MAJOR VESSELS AND AIRWAYS ANTERIOR MEDIASTINUM ANTERIOR TO MIDDLE MEDIASTINUM AND POSTERIOR TO STERNUM
- 5. HEITZMAN *HEITZMAN DIVIDES MEDIASTINUM INTO THE THORACIC INLET ANTERIOR MEDIASTINUM THE SUPRA AORTIC AREA THE INFRA AORTIC AREA THE SUPRA AZYGOS AREA THE INFRA AZYGOS AREA IN ANY METHOD THESE DIVISIONS ARE THEORITICAL RATHER THAN PHYSICAL.THEREFORE DISEASES CAN SPREAD FROM ONE TO ANOTHER COMPARTMENT.
- 9. ANTERIOR MEDIASTINUM BOUNDED:- ANTERIORLY-----STERNUM POSTERIOLY------PERICARDIUM SUPERIORLY------THORACIC INLET INFERIORLY------- DIAPHRAGM CONTENTS:-THYMUS LYMPHNODES FAT INTERNAL MAMMARY VSSELS MASSES CAN BE DIVIDED INTO PREVASCULAR AND PERICARDIAC MASSES.
- 10. ANTERIOR MEDIASTINAL MASSES THYMIC LESIONS Thymoma Thymic cyst Thymolipoma Thymic hyperplasia Thymic carcinoid Thymic carcinoma TERATOID LESIONS Dermoid cyst Teratoma Embryonal cell carcinoma Choriocarcinoma Seminoma Mixed germ cell tumor THYROID Goiter Adenoma Carcinoma LYMPH NODES Lymphoma Metastasis Benign nodal hyperplasia Angioblastic lymphoid adenopathy CVS Epiardial fat pad Aneurysm of ascending aorta Pericardial cyst Cardiac tumors CYSTS OTHERS Neural tumors of vagus and phreic nerves Paraganglioma Morgagnis,s hernia Hemangioma Pancreatis pseodocyst
- 11. MIDDLE MEDIASTINUM BOUNDED BY:- ANTERIORLY----PERICARDIUM POSTERIORLY---PERICADIUM ANDPOSTERIOR TRACHEAL WALL SUPERIORLY-----THORACIC INLET INFERIORLY------DIAPHRAGM CONTENTS:- HEART AND PERICARDIUM ASCEDING AND TRANSVERSE AORTA SVC IVC BRACHIOCEPHALIC VESSELS TRACHEA AND MAIN BRONCHI LYMPHNODES PHRENIC,VAGUS AND RECURRENT LARYNGEAL NERVES
- 12. MIDDLE MEDIASTINAL MASSES LYMPHADENOPATHY Metastasis Lymphoma Leukemiao Inflammatory— -TB,SAROIDOSIS PRIMARY TUMORS Bronchogenic ca Trachea ca Esophagus ca Duplication cysts Enteric cysts Bronchogenic cysts VASCULAR LESONS Aneurysms Hematoma Distended veins Left sided svc
- 13. POSTERIOR MEDIASTINUM BOUNDED :- ANTERIORLY------POSTERIOR TRACHEA AND PERICARDIUM ANTEROINFERIORLY---DIAPHRAGM POSTERIORLY-----VERTEBRAL COLUMN SUPERIORLY----THORACIC INLET CONTENTS:- ESOPHAGUS DESCENDING AORTA AZYGOS,HEMIAZYGOS VEIN THORACIC DUCT VAGUS AND SPLANCHNIC NERVES FAT LYMPHNODES
- 14. POSTERIOR MEDIASTINAL MASSES TRAUMA Thoracic aneurysm Hematoma Loculated hemothorax Traumatic pseudomeningocele DEVELOPMENTAL LESION Enteric cysts Neurenteric cyst Bronchogenic cyst Extra lobar sequestration ABDOMINAL DISEASE Bochdalek hernia Pancreatic pseudo cyst Retroperitoneal mass OTHERS Extra medullaryhematopoises Lateral meningocele NEOPASMS NEUROGENIC TUMORS ganglion series tumors nerve root tumors paraganglioma METASTASIS LYMPHOMAS MESENCHYMAL TUMORS THYROID LESIONS HEMANGIOMAS VERTEBRAL TUMORS INFLAMMATION Paraspinous abscess Mediastinitis Sarcoidosis Lymphoid hyperplasia VASCULAR LESION
- 28. Anterior mediastinal masses(50%). The anterior mediastinal masses usually displaced the anterior junctional line, obliterate the cardiophrenic angle and the retro-sternal space with hilum overlay sign. 1- Retro-sternal goiter. 2- Tortuous innominate artery. 3- Fat deposition. 4- Enlarged lymph nodes. 5- Ascending aortic aneurysm. 6- Thymoma. 7- Germ cell tumour. 8- Pleuro-pericardial cyst. 9- Morgagni hernia. 10- Para-thyroid adenoma.
- 30. Middle mediastinal masses(25%). The middle mediastinal masses widened the para-tracheal stripes, displaced the azygo-oesophageal recess on right side. 1- Lymph nodes enlargement. 2- Aortic arch aneurysm. 3- Enlarged pulmonary artery. 4- Dilated superior vena cava. 5- Bronchogenic cyst. 6- Tracheal lesions. 7- Cardiac tumours.
- 35. Posterior mediastinal masses(25%). 1- Neurogenic tumours. 2- Pharyngio-esophygeal pouch. 3- Descending thoracic aortic aneurysm. 4- Hiatus hernia. 5- Esophageal lesions. 6- Para-vertebral masses. 7- Neuroenteric cysts. 8- Bochdalek hernia. 9- Pancreatic pseudocyst. 10- Abscess. 11- Fibrosis. 12- Extra-medullary hematopoiesis. 13- Lateral meningocele.
- 40. Lymph nodes
Hinweis der Redaktion
- THE FELSON METHOD IS BASED UPON FINDINGS AT LATERAL CHEST RADIOGRAPHY.A LINE EXTENDING FROM DIAPHRAGM TO THORACIC INLET ALONG THE BACK OF HEART AND ANTERIOR TO TRACHEA SEPARATES ANTERIOR AND MIDDLE MEDIASTINAL COMPARTMENTS WHERE AS A LINE THAT CONNECTS POINTS 1 CM BEHIND THE ANTERIOR MARGINS OF VERTEBRAL BODIES SEPARATES MIDDLE AND POSTERIOR COMPARTNENTS