Transcript Imaging Anatomy of the Mediastinum - Learning

Dr. Flip Otto
Dept. of Radiology
Universitas Academic Hospital
• 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
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
4
3 5 6
1 7
2
1-trachea
4-left brachiocephalic vein
6-left common carotid artery
2-oesophagus
3-right braciocephalic vein
5-right brachiocephalic artery
7-left subclavian artery
4
5 1 2
3
1-trachea
4-superior vena cava
2-aortic arch
5-arch of azygos vein
3-oesophagus
7 3
2
6 8
10
9
1
11
5
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
3
1
4
6
7
1-aortic root
4-left atrium
7-azygos vein
2-right ventricular outflow tract
5-descending aorta
2
5
3-right atrial appendage
6-oesophagus
2
5
1
3
7
6
8
1-right atrium
4-left ventricle
6-descending aorta
2-right ventricle
3-left atrium
5-left ventricular outflow tract and aortic valve
7-oesophagus
8-azygos vein
4
3 4
2
1
5
1-descending aorta
2-fundus of stomach
4-oesophago-gastric junction
3-inferior vena cava
5-spleen
• Lines:
• Anterior junction line
• Posterior junction line
• Stripes:
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•
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•
Right paratracheal stripe
Left paratracheal stripe
Posterior tracheal stripe
Posterior wall of bronchus intermedius
• Interfaces:
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•
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Right paraspinal line
Left paraspinal line
Aortic-pulmonary stripe
Azygo-oesophageal recess
Volume loss in right lung with rightward displacement of anterior junction line
following a right middle lobectomy
Widening of right paratracheal stripe caused by a large ectopic parathyroid
adenoma. Note diffuse osteopenia from hyperparathyroidism.
Widening of left paratracheal stripe with mass effect on the trachea due to
large thyroid carcinoma and associated supraclavicular lymphadenopathy
Widening of the posterior tracheal stripe due to dilated esophagus in a patient
with achalasia.
Diffuse bandlike thickening of the
posterior wall of the bronchus
intermedius in a patient with
pulmonary oedema.
Abnormal bulge in right paraspinal line inferiorly due to mediastinal
hematoma from multiple right sided transverse process fractures and an
associated hemothorax.
Focal lateral bulge in left paraspinal line due to extensive esophageal varices
in patient with liver cirrhosis.
Abnormal contour of the aortic-pulmonary stripe due to lymphoma with anterior
mediastinal lymphadenopathy within the prevascular space.
Abnormal contour and right lateral convexity of distal third of
azygoesophageal recess due to a large hiatal hernia.
• Four named spaces surrounding the central airways:
•
•
•
•
Pretracheal space
Aortopulmonary window
Subcarinal space
Right paratracheal space
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.
• American Thoracic Society definitions
of regional lymph node stations
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•
•
•
•
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X
2R
2L
4R
4L
5
6
7
8
9
10R
10L
11
Supraclavicular nodes
Right upper paratracheal nodes
Left upper paratracheal nodes
Right lower paratracheal nodes
Left lower paratracheal nodes
Aortopulmonary nodes
Anterior mediastinal nodes
Subcarinal nodes
Paraesophageal nodes
Right or left pulmonary ligament nodes
Right tracheobronchial nodes
Left tracheobroncheal nodes
Intrapulmonary nodes
• 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
• 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, 3rd 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