Mediastinal mass

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Mediastinal mass Microchapters

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Overview

Anatomy of Mediastinum

Causes

Differentiating Mediastinal Mass from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Amr Marawan, M.D. [3]

Synonyms and keywords: Mediastinal enlargement; mass in the mediastinum

Overview

The mediastinum is a non-delineated group of structures in the thorax (chest), surrounded by loose connective tissue. It is the central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, esophagus, trachea, thymus, and lymph nodes of the central chest. A wide variety of diseases involving these organs can present as a mediastinal mass or widening of the mediastinum on imaging studies. Mediastinal widening is diagnosed by the mediastinum measuring greater than 8 cm in width on PA chest x-ray. The mediastinal mass may present with symptoms caused by the mass pressing against other organs or even without any symptoms. Mediastinal masses can be differentiated on the basis of location in the mediastinal cavity into 3 groups: Prevascular, visceral and paravertebral.

Intenational Thymic Malignancy Interest Group (ITMIG) Classification
Compartments Boundaries Components
Prevascular
  • Superior: Thoracic inlet
  • Inferior: Diaphragm
  • Anterior: Sternum
  • Posterior: Anterior aspect of the pericardium
  • Lateral: Parietal mediastinal pleura
  • Thymus
  • Fat
  • Lymph nodes
  • Left brachiocephalic vein
Visceral
  • Superior: Thoracic inlet
  • Inferior: Diaphragm
  • Anterior: Posterior boundaries of prevascular compartment
  • Posterior: Vertical line connecting a point on each thoracic vertebral body 1 cm posterior to its origin
  • Non vascular:
    • Trachea
    • Carina
    • Esophagus
    • Lymph nodes
  • Vascular:
    • Heart
    • Ascending thoracic aorta
    • Aortic arch
    • Descending thoracic aorta
    • Superior vena cava
    • Intrapericardial pulmonary arteries
    • Thoracic duct
Paravertebral
  • Superior: Thoracic inlet
  • Inferior: Diaphragm
  • Anterior: Posterior bounderies of visceral compartment
  • Posterolateral: Vertical line agaiinst the posterior margin of the chest wall at the lateral margin of the transvers process of tthoracicspine
  • Lateral
  • Thoracic spine
  • Paravertebral soft tissues
Adapted from Radiographics

References