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Mediastinum

Dr Henry Knipe and Dr Jeremy Jones et al.

The mediastinum contains a group of non-deliniated organs and their surrounding connective tissue. It lies in the midline of the chest between the pleural surfaces of each lung and extends from the sternum to the vertebral column.

Anatomy

The mediastinum contains all the thoracic viscera except the lungs: heart and great vessels, oesophagus, trachea, phrenic nerve, cardiac nerve, thoracic duct, thymus, and mediastinal lymph nodes.

Anatomical division

The mediastinum can be divided into parts based on their relationship to the pericardium:

superior mediastinum - above the upper level of the pericarcium which is at the level of the sternoclavicular notch and clavicles
anterior mediastinum - anterior to the pericardium
middle mediastinum - within the pericardium
posterior mediastinum - posterior to the pericardium

Anatomic relations

superiorly - continuous with the loose connective tissue of the neck
anteriorly - chest wall
laterally - lungs and pleura
posteriorly - thoracic spine
inferiorly - diaphragm

Related pathology

Broadly, pathology that affects the mediastinum can be divided into those that result in a focal mass, or those that result in diffuse disease involving the mediastinum. Additionally, air may track into the mediastinum in pneumomediastinum.

The differential diagnosis of a focal mediastinal mass is highly dependant on its location within the mediastinum, resulting in specific differential lists for

Diffuse mediastinal disease can be separated into groups depending on whether the mediastinal disease is smooth or lobulated:

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