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7/31/2019 A Diagnostic Approach to Medias Tin Um
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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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THANK YOU