MEDIASTINAL

SYNDROMES

MEDIASTINUM
TOPOGRAPHIC REGION THAT
SERVES AS A PASSING CHANNEL FOR
SOME ANATOMICAL ELEMENTS OF
VITAL IMPORTANCE

MEDIASTINUM
BORDERS
SUP

THORACIC INLET T1 C1

LAT

PLEURA

POST

SPINE

ANT

STERNUM

INF

DIAPHRAGM

MEDIASTINUM- CONTENTS
RESPIRATORY system

TRACHEA
MAJOR BRONCHI
PLEURA

DIGESTIVE system

ESOPHAGUS

CARDIOVASCULAR system

HEART
PERICARDUM

MEDIASTINUM - CONTENTS
ARTERIES
AORTA

ASCENDENT
ARCH: CONCAVITY, CONVEXITY

DESCENDENT

BRACHIOCEPHALIC
LEFT COMMON CAROTID
LEFT SUBCLAVIAN
PULMONARY with his two branches

VEINS
SUPERIOR CAVA + 2 BRACHIOCEPHALIC
AZYGOS SYSTEM
INFERIOR CAVA
PULMONARY

MEDIASTINUM - CONTENTS
LYMPHATICS
THORACIC DUCT
LYMPH NODES
ANTERO-SUPERIOR group
MIDDLE group
POSTERIOR group

MEDIASTINUM - CONTENTS
NERVES
VAGUS (POSTERIOR MEDIASTINUM)
LEFT RECURRENT LARYNGEAL
RIGHT RECURRENT LARYNGEAL
PHRENICS
ANTERIOR MEDIASTINUM
OVER THE LEFT VENTRICLE

SYMPATHETICS CHAINS
INTERCOSTALS

MEDIASTINUM - CONTENTS
ENDOCRINE glands
THYMUS
THIROID
PARATHYROIDS

ADIPOSE AND CONJUNCTIVE TISSUE

MEDIASTINUM COMPARTMENTS
ANTEROSUPERIOR (VASCULAR and GLANDULAR)
TRACHEA
THYMUS
AORTIC ARCH
GREAT ARTERIES

SUPERIOR CAVA
AZYGOS/HEMIAZYGOS V.
SUPERIOR MEDIASTINAL LYMPH NODES
THYROID, PARATHYROIDS
CONJUNCTIVE TISSUE

MEDIASTINUM COMPARTMENTS
MIDDLE (VISCERAL)
HEART (PERICARDUM)
ASCENDENT AORTA
CONCAVITY OF THE AORTIC ARCH
LEFT RECURRENT LARYNGEAL NERVE
TRACHEA and its BIFURCATION
MAJOR BRONCHI
PULMONARY VEINS
PARATRACHEAL LYMPH NODES

MEDIASTINUM COMPARTMENTS
POSTERIOR (PARAVERTEBRAL)
ESOPHAGUS
VAGUS NERVE
THORACIC DUCT

ASCENDENT AORTA
SYMPATHETICS CHAINS

POSTERIOR MEDIASTINAL LYMPH NODES

INTERCOSTAL NERVES

MEDIASTINUM SEMIOLOGY
RATIONAL SYMPTOMS and SIGNS
RESPIRATORY
DYSPNEA
CONTINOUS, INSPIRATORY (trachea, bronchi)
PAROXISMAL
ASTHMA-like (vagus)
LARYNGOSPASM (recurrent laryngeal)
COUGH

DRY
BITONAL

VOICE CHANGES

HOARSENESS (DYSPHONIA), BITONAL

APHONIA

MEDIASTINUM SEMIOLOGY
DIGESTIVE
DYSPHAGIA
PERSISTENT kalc devaml (COMPRESSION)
INTERMITENT kesik kesik,aralkl(VAGUS)
ESOPHAGEAL EMESIS (VOMITING)

CARDIAC
RHYTHM DISTURBANCES(VAGUS)
PERICARDITIS

pericarditis Inflammation of the pericardium, the membrane that

surrounds the heart

MEDIASTINUM SEMIOLOGY
VASCULAR
ARTERIAL
AORTIC PULSATION in STERNOCLAVICULAR AREA
DIMINISHED/ABOLISHED RADIAL PULSE (subclavian compression)
PULSUS PARADOXUS (aortic compression)
OLIVER CARDARELLI sign
ARTERIAL MURMURS

MEDIASTINUM SEMIOLOGY
VASCULAR
VENOUS
SUPERIOR CAVA VEIN OBSTRUCTION

VENOUS HYPERTENSION
HEADACHE
LETHARGY
EPISTAXIS burun kanamas
SWELLING and CYANOSIS of FACE, NECK, ARMS
MARKED COLLATERAL CIRCULATION
JUGULAR VEINS DISTENSION
VENOUS STASIS

BRACHIOCEPHALIC VEIN OBSTRUCTION

RETINIAN STASIS

IPSILATERAL SWELLING

SUPERIOR CAVA VEIN COMPRESSION SYNDROME

SUPERIOR CAVA VEIN COMPRESSION SYNDROME

MEDIASTINUM SEMIOLOGY
VASCULAR
VENOUS
INFERIOR CAVA VEIN COMPRESSION
LOWER LIMBS SWELLING
HEPATOMEGALY, ASCITIS
PULMONARY VEINS COMPRESSION

PULMONARY STASIS
HEMOPTYSIS
HYDROTHORAX

AZYGOS VEIN COMPRESSION

RIGHT HYDROTHORAX

LYMFATICS
THORACIC DUCT COMPRESSION CHYLOTHORAX

MEDIASTINUM SEMIOLOGY
ENDOCRINE
INTRATHORACIC GOITER

HYPO/HYPERfunction

PARATHIROID

HYPERPARATHIROIDISM

THYMUS

MIASTENIA GRAVIS

CONJUNCTIVE TISSUE

SUPPURATIONS

PNEUMOMEDIASTINUM

INTRATHORACIC GOITER

MEDIASTINUM SEMIOLOGY
NERVES
PAIN
1. LOCALISATION: RETROSTERNAL, INTERSCAPULARVERTEBRAL
2. RADIATION: ANTERIOR CERVICAL

3. DURATION: PERSISTENT devaml (from 0 to extreme)

4. INTENSITY: VARIABLE

5. DEBUT is INSIDIOUS
6,7. influenced by the intrathoracic pressure changes

MEDIASTINUM SEMIOLOGY
NERVES

VAGUS

PHRENIC

IRITATION

PARALYSIS

BRONCHOSPASM
ESOPHAGIAN SPASM
BRADYCARDIA

TACHYCARDIA

HICCUPS

DIAPHRAGM
HYPOTONIA

MEDIASTINUM SEMIOLOGY
NERVES
INTERCOSTAL NEURALGIA
CERVICAL SYMPATHETIC CHAIN lesion
sd. CLAUDE-BERNARD-HORNER
MIOSIS
PALPEBRAL PTOSIS
ENOPHTALMOS

CERVICO BRACHIAL NEURALGIA

MEDIASTINUM SEMIOLOGY
CLINICAL EXAMINATION FINDINGS
INSPECTION
ADENOPATHIC THORAX
RETRACTION
COLATERALL CIRCULATION
JUGULAR VEINS DISTENSION
SWELLING

PALPATION
SENSIBILITY
PECTORAL FREMITUS CHANGES

MEDIASTINUM SEMIOLOGY
MODIFICARI LA EXAMENUL OBIECTIV
PERCUTION
PARAMANUBRIAL DULLNESS
INTERSCAPULARVERTEBRAL DULLNESS
C7 T4 DULLNESS

AUSCULTATION
LOCALISED DIMINISHED/ABOLISHED BREATH SOUNDS
BRONCHIAL SOUND
VERTEBRAL BRONCHOPHONY
PECTORILOQUI

MEDIASTINUM SEMIOLOGY
RADIOLOGY and COMPUTED TOMOGRAPHY

Establish the diagnostic

WIDENED mediastinal shadow (esp. in the superior region)

- CAN BE:
REGULAR: MEDIASTINITIS (fine layers)
IRREGULAR: TUMORS (usually polycyclic)

In some particular situations:

Expanded tumor related to the aorta: AORTIC ANEURYSM
Polycyclic shadows: LYMPHADENOPATHIES
TUMOR, ATELECTASIA: PULMONARY CANCER
RISING WHEN SWALLOWING: INTRATHORACIC GOITER
PRINTING THE ESOPHAGUS

COMPUTED TOMOGRAPHY the most reliable examination

WIDENED MEDIASTINUM

MEDIASTINAL LYMPHADENOPATHY

MEDIASTINAL SYNDROMES
ANTERO-SUPERIOR MEDIASTINAL Sd.
SUPERIOR CAVA VEIN Sd.

BRACHIOCEPHALIC VEIN Sd.

CAUSIS

SUPERIOR PULMONARY LOBE NEOPLASM

AORTIC ARCH ANEURYSM
INTRATHORACIC GOITER
THYMOMA
LYMPHOMAS

MEDIASTINAL ABCESSES

MEDIASTINAL SYNDROMES
MIDDLE MEDIASTINAL Sd.
BRONCHO-RECURRENTAL

AORTIC ARCH ANEURYSM

CAUSIS
BRONCHOPULMONARY CANCER
METASTASIS
LYMPHOMA

MEDIASTINAL SYNDROMES
POSTERIOR MEDIASTINAL Sd.
ESOPHAGIAN disorders

CLAUDE-BERNARD-HORNER sd.
VAGUS irritation/paralysis sd.
CAUSIS
ESOPHAGIAN DISEASES
DESCENDENT AORTIC ANEURYSM atardamar

genilemesi
NEUROGENIC TUMORS
PULMONARY NEOPLASM

MEDIASTINAL SYNDROMES
ACUTE MEDIASTINITIS
ACUTE MEDIASTINAL SUPPURATION

MEDIASTINAL ABSCESS
MEDIASTINAL PLEURAL EFFUSION szma
CLINICAL:

PAIN

INFECTIOUS sign

DYSPNEA nefes darl

DYSPHAGIA yutkunma zorluu

MEDIASTINAL SYNDROMES
PNEUMOMEDIASTINUM (mediastinal emphysema)
Introduction of air from esophagus, tracheobronchial tree, neck, or abdomen
Causes: penetrating or blunt trauma, or spontaneous mediastinal emphysema
CLINIC:

SUBSTERNAL CHEST PAIN

DYSPNEA nefes darl
CREPITATION

MEDIASTINAL SYNDROMES
MEDIASTINAL HEMORRAGES
AORTIC DISSECTION

ANEURYSM RUPTURE
COAGULOPATHIES

Phtlama bozukluu, kann phtlamasnda

bozukluk ile belirgin herhangi bir durum