Mediastinum

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.

Anatomy

The mediastinum lies between the right and left pleuræ in and near the median sagittal plane of the chest. It extends from the sternum in front to the vertebral column behind, and contains all the thoracic viscera except the lungs. It may be divided for purposes of description into two parts:

an upper portion, above the upper level of the pericardium, which is named the superior mediastinum;
and a lower portion, below the upper level of the pericardium. This lower portion is again subdivided into three parts, viz.:
- that in front of the pericardium, the anterior mediastinum;
- that containing the pericardium and its contents, the middle mediastinum;
- and that behind the pericardium, the posterior mediastinum.

It is surrounded by the chest wall anteriorly, the lungs laterally and the spine posteriorly. It is continuous with the loose connective tissue of the neck, and extends inferiorly onto the diaphragm.

Structures inside the mediastinum include (note that clinical radiologists and anatomists categorize the mediastinum in slightly different ways):

Superior mediastinum

The Superior Mediastinum (Fig. 967) is that portion of the interpleural space which lies between the manubrium sterni in front, and the upper thoracic vertebræ behind. It is bounded below by a slightly oblique plane passing backward from the junction of the manubrium and body of the sternum to the lower part of the body of the fourth thoracic vertebra, and laterally by the pleuræ. It contains the origins of the Sternohyoidei and Sternothyreoidei and the lower ends of the Longi colli; the aortic arch; the innominate artery and the thoracic portions of the left common carotid and the left subclavian arteries; the innominate veins and the upper half of the superior vena cava; the left highest intercostal vein; the vagus, cardiac, phrenic, and left recurrent nerves; the trachea, esophagus, and thoracic duct; the remains of the thymus, and some lymph glands.

Inferior mediastinum

The Anterior Mediastinum (Fig. 968) exists only on the left side where the left pleura diverges from the mid-sternal line. It is bounded in front by the sternum, laterally by the pleuræ, and behind by the pericardium. It is narrow, above, but widens out a little below. Its anterior wall is formed by the left Transversus thoracis and the fifth, sixth, and seventh left costal cartilages. It contains a quantity of loose areolar tissue, some lymphatic vessels which ascend from the convex surface of the liver, two or three anterior mediastinal lymph glands, and the small mediastinal branches of the internal mammary artery.

Middle

The Middle Mediastinum (Fig. 968) is the broadest part of the interpleural space. It contains the heart enclosed in the pericardium, the ascending aorta, the lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery dividing into its two branches, the right and left pulmonary veins, the phrenic nerves, and some bronchial lymphatic glands.

Posterior

The Posterior Mediastinum (Figs. 968, 969) is an irregular triangular space running parallel with the vertebral column; it is bounded in front by the pericardium above, and by the posterior surface of the diaphragm below, behind by the vertebral column from the lower border of the fourth to the twelfth thoracic vertebra, and on either side by the mediastinal pleura. It contains the thoracic part of the descending aorta, the azygos and the two hemiazygos veins, the vagus and splanchnic nerves, the esophagus, the thoracic duct, and some lymph glands.

Role in disease

The mediastinum is frequently the site of involvement of various cancers. Masses in the anterior portion of the mediastinum can include thymoma, lymphoma, and teratoma. Lung cancer typically spreads to the lymph nodes in the mediastinum.

Mediastinitis is inflammation of the tissues in the mediastinum, usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress very quickly, this is a serious condition.

Pneumomediastinum is the presence of air in the mediastinum, which can lead to pneumothorax, pneumoperitoneum, and pneumopericardium if left untreated in some cases, though that does not always happen and sometimes those conditions actually are the cause, not the result, of pneumomediastinum.

These two conditions frequently accompany Boerhaave's syndrome, or spontaneous esophageal rupture.

External links

Thorax

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