Diseases of Mediastinum & Pleura

Question 1

Contents of the anterior-superior mediastinum

Answer 1

• great vessels and aortic root
• the thymus gland
• inferior aspects of the trachea and esophagus

Question 2

Contents of posterior mediastinum

Answer 2

• interfaces with the paravertebral sulci and anterior vertebral column
• spinal nerve roots ==> form intercostal nerves
• sympathetic chain
• thoracic duct
• descending aorta

Question 3

Contents of middle mediastinum

Answer 3

• middle mediastinum = space bounded by the pericardium anteriorly, the vertebral bodies posteriorly, diaphragm inferiorly and pleura laterally
• contains within its confines the only true mediastinal compartment, the pericardial sac.

Question 4

Tumors of the anterior mediastinum

Answer 4

• “terrible T’s”
• Thymoma
• Tetratoma/GCT
• {terrible} lymphoma
• thyroid tissue

Question 5

Major clinical syndromes of the anterior/anterior-superior mediastinum

Answer 5

• thymic masses = majority of masses
  
  • malignant = thymoma w/myasthenia gravis + locally invasive
  • benign = thymic cyts
• thyroid
  
  • substernal thyroid goiter
• lymph tissue
  
  • benign = germ-cell tumors/tetratoma
  • malignant germ-cell tumors
  • lymphoma

Question 6

Major clinical syndromes of the middle mediastinum

Answer 6

• pericardial sac = pericardial cysts ==> compression
• proximal airways = bronchogenic cysts
• esophagus = enteric cysts
• lymphatics = lymphadenopathy is most common mass of middle mediastinum
  
  • caused by lymphoma, sarcoid, lung cancer

Question 7

Major clinical syndromes of the posterior mediastinum

Answer 7

• Spinal nerve roots/Intercostal nerves
  
  • Neurinomas (benign tumors of the peripheral nerves) = most common masses found in the posterior mediastinum ( > 60%)
  • Benign = schwannomas/ neurofibromas,

ganglioneuromas

* Neuroblastomas and ganglioneuroblastomas are malignant and arise from the sympathetic ganglia
    * most commonly present during childhood

Question 8

Diagnostic procedures used to evaluate abnormalities of pleural space

Answer 8

• CXR ==> pneumothorax, pleural effusion
• Ultrasound

Question 9

Transudative vs. Exudative pleural effusions

Answer 9

• Exudate
  
  • protein, LDH, cells ++
• Transudate
  
  • primarly fluid

Question 10

Common abnormalities w/in pleural space

Answer 10

• pneumothorax
  
  • spontaneous
  • traumatic
  • tension pneumothorax
• pleural effusions
  
  • transudative <== CHF, cirrhosis w/ascites
  • exudative <== infection, cancer, PE, autoimmune disease
• pleural thickening
• pleural plaques
• pleural tumors