Imaging Anatomy of the Mediastinum - Learning - Home

Imaging Anatomy of the Mediastinum - Learning - Home

Imaging Anatomy of the Mediastinum Dr. Flip Otto Dept. of Radiology Universitas Academic Hospital Outline Mediastinal devisions Content of mediastinum

Mediastinal contours on PA chest radiograph Cross sectional anatomy of mediastinum Mediastinal lines and stripes on conventional radiography and CT correlation Mediastinal spaces Mediastinal lymphnodes Mediastinal devisions Devisions used to describe location of

pathological processes: Superior mediastinum: Above line from lower border T4 to sternal angle Anterior mediastinum: Between anterior part of heart and sternum

Middle mediastinum: Occupied by heart and its vessels Posterior mediastinum: Between posterior part of heart and thoracic spine Mediastinal contents

Mediastinal contours on PA chest radiograph Cross sectional Anatomy on CT T3 level 4 3 56 1 7 2

1-trachea 2-oesophagus 3-right braciocephalic vein 4-left brachiocephalic vein 5-right brachiocephalic artery 6-left common carotid artery 7-left subclavian artery Cross sectional Anatomy on CT T4 level

4 51 2 3 1-trachea 2-aortic arch 3-oesophagus 4-superior vena cava 5-arch of azygos vein

Cross sectional Anatomy on CT T5 level 7 3 2 6 8 10 9 1

1 5 1 12 4 1-main pulmonary trunk 2-right pulmonary artery 3-ascending aorta 4-descending aorta 5-left main bronchus

6-right main bronchus 7-superior vena cava 8-oesophagus 9-azygos vein 10-azygoesophageal recess 11-left superior pulmonary vein 12-left descending lower-lobe artery Cross sectional Anatomy on CT T6 level 3

1 6 4 7 1-aortic root 4-left atrium

7-azygos vein 2 5 2-right ventricular outflow tract 3-right atrial appendage 5-descending aorta 6-oesophagus

Cross sectional Anatomy on CT T8 level 2 5 1 3 4

7 6 8 1-right atrium 2-right ventricle 3-left atrium 4-left ventricle 5-left ventricular outflow tract and aortic valve 6-descending aorta

7-oesophagus 8-azygos vein Cross sectional Anatomy on CT T10 level 3 4 2

1 5 1-descending aorta 2-fundus of stomach 3-inferior vena cava 4-oesophago-gastric junction 5-spleen Mediastinal lines and stripes- Correlation

between plain chest radiography and CT Lines: Anterior junction line Posterior junction line Stripes:

Right paratracheal stripe Left paratracheal stripe Posterior tracheal stripe Posterior wall of bronchus intermedius Interfaces:

Right paraspinal line Left paraspinal line Aortic-pulmonary stripe Azygo-oesophageal recess Anterior junction line Abnormal anterior junction line

Volume loss in right lung with rightward displacement of anterior junction line following a right middle lobectomy Posterior junction line Right paratracheal stripe Abnormal right paratracheal stripe

Widening of right paratracheal stripe caused by a large ectopic parathyroid adenoma. Note diffuse osteopenia from hyperparathyroidism. Left paratracheal stripe Abnormal left paratracheal stripe

Widening of left paratracheal stripe with mass effect on the trachea due to large thyroid carcinoma and associated supraclavicular lymphadenopathy Posterior tracheal stripe Abnormal posterior tracheal stripe Widening of the posterior tracheal stripe due to dilated

esophagus in a patient with achalasia. Posterior wall of bronchus intermedius Abnormal posterior wall of bronchus intermedius Diffuse bandlike thickening of the posterior

wall of the bronchus intermedius in a patient with pulmonary oedema. Right paraspinal line Abnormal right paraspinal line Abnormal bulge in right paraspinal line inferiorly due to mediastinal hematoma from multiple right sided transverse

process fractures and an associated hemothorax. Left paraspinal line Abnormal left paraspinal line Focal lateral bulge in left paraspinal line due to extensive esophageal varices in patient with liver cirrhosis. Aortic-pulmonary stripe

Abnormal aortic-pulmonary stripe Abnormal contour of the aortic-pulmonary stripe due to lymphoma with anterior mediastinal lymphadenopathy within the prevascular space. Azygoesophageal recess

Abnormal azygoesophageal recess Abnormal contour and right lateral convexity of distal third of azygoesophageal recess due to a large hiatal hernia. Mediastinal spaces Four named spaces surrounding the central airways:

Pretracheal space Aortopulmonary window Subcarinal space Right paratracheal space Aortopulmonary window

Abnormal aortopulmonary window Abnormal bulge in AP window due to significant soft tissue mass within AP window and subcarinal space compatible with metastatic lymphadenopathy in a patient with bronchogenic carcinoma. Also widened right paratracheal stripe due to lymphadenopathy and left lower lobe consolidation.

Mediastinal lymphnodes American Thoracic Society definitions of regional lymph node stations

X Supraclavicular nodes 2R Right upper paratracheal nodes 2L Left upper paratracheal nodes

4R Right lower paratracheal nodes 4L Left lower paratracheal nodes 5 Aortopulmonary nodes 6 Anterior mediastinal nodes 7 Subcarinal nodes 8 Paraesophageal nodes

9 Right or left pulmonary ligament nodes 10R Right tracheobronchial nodes 10L Left tracheobroncheal nodes 11 Intrapulmonary nodes Conclusion Traditional frontal and lateral chest radiography remains a valuable tool in the evaluation of chest

disease despite increased reliance on CT, therefore familiarity with anatomic basis of mediastinal lines and stripes as seen on radiography imperative. Knowledge of normal anatomic structures within different mediastinal divisions helps guide formulation of appropriate differential diagnosis References Butler, P., Mitchell, A.W.M., Ellis, H. (1999). Applied

Radiological Anatomy. Cambridge: Cambridge University Press Ellis, H., Logan, B.M., Dixon, A.K. (2007). Human Sectional Anatomy Atlas of body sections, CT and MRI images, 3 rd ed. London: Hodder Arnold Gibbs, J.M., Chandrasekhar, C.A., Ferguson, E.C. et al. (2007). Lines and Stripes: Where did they go? From Conventional Radiography to CT. Radiographics, 27:33-48. Netter, F.H. (2011). Atlas of Human Anatomy, 5th ed. Philadelphia: Saunders Elsevier

Ryan, S., McNicholas, M., Eustace, S. (2011). Anatomy for diagnostic imaging, 3rd ed. London: Saunders Elsevier

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