THE MEDIASTINUM

THE MEDIASTINUM

The mediastinum refers to the central area in the chest between the thoracic inlet and the diaphragm, between the right and left pleural surfaces, and which extends from the inner aspect of the sternum to the vertebral column. It contains the heart, great /uni00A0 vessels, trachea and oesophagus and is arbitrarily subdivided into compartments (superior, inferior, anterior, middle and posterior). Many of the regional lymph node chains draining the chest and its organs are also found

in the mediastinum. Various surgical procedures to approach structures, and particularly lymph nodes, in the mediastinum are performed, usually as diagnostic procedures. The surgical approach when mediastinal tumours require resection depends on the anatomical location of the tumour ( Figure 60.22 and includes median sternotomy for anterior mediastinal pathology , thoracotomy or V ATS for posterior mediastinal pathology and transcervical (neck incisions) for superior mediastinal pathology . The middle mediastinum can usually be approached through thoracotomy or V ATS. Increasingly , a robotic or RATS approach is used, particularly for anterior mediastinal tumours such as thymomas.

mediastinum mediastinum Thymoma Lymphoma Lymphoma Thyroid Germ cell tumour Parathyroid Middle mediastinum Cystic lesions Lymphoma Mesenchymal tumours Posterior mediastinum Neurogenic tumours Cystic lesions Mesenchymal tumours Figure 60.22 Mediastinal pathology. Subdivisions of the mediastinum with the most common mediastinal masses.