MEDIASTINAL SYNDROMES

1. MEDIASTINAL SYNDROMES

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

3. MEDIASTINUM BORDERS SUP THORACIC INLET T1 � C1 LAT PLEURA POST SPINE ANT STERNUM INF DIAPHRAGM

4. MEDIASTINUM- CONTENTS RESPIRATORY system DIGESTIVE system ESOPHAGUS CARDIOVASCULAR system

5. MEDIASTINUM - CONTENTS ARTERIES AORTA BRACHIOCEPHALIC LEFT COMMON CAROTID LEFT SUBCLAVIAN PULMONARY with his two branches VEINS SUPERIOR CAVA + 2 BRACHIOCEPHALIC AZYGOS SYSTEM INFERIOR CAVA PULMONARY

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

7. MEDIASTINUM - CONTENTS NERVES VAGUS (POSTERIOR MEDIASTINUM) LEFT RECURRENT LARYNGEAL RIGHT RECURRENT LARYNGEAL PHRENICS ANTERIOR MEDIASTINUM OVER THE LEFT VENTRICLE SYMPATHETICS CHAINS INTERCOSTALS

8. MEDIASTINUM - CONTENTS ENDOCRINE glands THYMUS THIROID PARATHYROIDS ADIPOSE AND CONJUNCTIVE TISSUE

9. 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

10. 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

11. MEDIASTINUM � COMPARTMENTS POSTERIOR (PARAVERTEBRAL) ESOPHAGUS VAGUS NERVE THORACIC DUCT ASCENDENT AORTA SYMPATHETICS CHAINS POSTERIOR MEDIASTINAL LYMPH NODES INTERCOSTAL NERVES

12. MEDIASTINUM SEMIOLOGY RESPIRATORY DYSPNEA CONTINOUS, INSPIRATORY (trachea, bronchi) PAROXISMAL ASTHMA-like (vagus) LARYNGOSPASM (recurrent laryngeal) COUGH DRY BITONAL VOICE CHANGES HOARSENESS (DYSPHONIA), BITONAL APHONIA

13. MEDIASTINUM SEMIOLOGY DIGESTIVE DYSPHAGIA PERSISTENT (COMPRESSION) INTERMITENT (VAGUS) ESOPHAGEAL EMESIS (VOMITING) CARDIAC RHYTHM DISTURBANCES(VAGUS) PERICARDITIS

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

15. VASCULAR VENOUS SUPERIOR CAVA VEIN OBSTRUCTION VENOUS HYPERTENSION HEADACHE LETHARGY EPISTAXIS SWELLING and CYANOSIS of FACE, NECK, ARMS MARKED COLLATERAL CIRCULATION JUGULAR VEINS DISTENSION VENOUS STASIS BRACHIOCEPHALIC VEIN OBSTRUCTION RETINIAN STASIS IPSILATERAL SWELLING MEDIASTINUM SEMIOLOGY

16. SUPERIOR CAVA VEIN COMPRESSION SYNDROME

17. SUPERIOR CAVA VEIN COMPRESSION SYNDROME

18. 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

19. ENDOCRINE INTRATHORACIC GOITER HYPO/HYPERfunction PARATHIROID HYPERPARATHIROIDISM THYMUS MIASTENIA GRAVIS CONJUNCTIVE TISSUE SUPPURATIONS PNEUMOMEDIASTINUM MEDIASTINUM SEMIOLOGY

20. INTRATHORACIC GOITER

21. NERVES PAIN LOCALISATION: RETROSTERNAL, INTERSCAPULARVERTEBRAL RADIATION: ANTERIOR CERVICAL DURATION: PERSISTENT (from 0 to extreme) INTENSITY: VARIABLE DEBUT is INSIDIOUS 6,7. influenced by the intrathoracic pressure changes MEDIASTINUM SEMIOLOGY

22. NERVES MEDIASTINUM SEMIOLOGY

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

24. CLINICAL EXAMINATION FINDINGS INSPECTION ADENOPATHIC THORAX RETRACTION COLATERALL CIRCULATION JUGULAR VEINS DISTENSION SWELLING PALPATION SENSIBILITY PECTORAL FREMITUS CHANGES MEDIASTINUM SEMIOLOGY

25. 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

26. 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 MEDIASTINUM SEMIOLOGY

27. WIDENED MEDIASTINUM

28. MEDIASTINAL LYMPHADENOPATHY

29. 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

30. MEDIASTINAL SYNDROMES MIDDLE MEDIASTINAL Sd. BRONCHO-RECURRENTAL AORTIC ARCH ANEURYSM CAUSIS BRONCHOPULMONARY CANCER METASTASIS LYMPHOMA

31. MEDIASTINAL SYNDROMES POSTERIOR MEDIASTINAL Sd. ESOPHAGIAN disorders CLAUDE-BERNARD-HORNER sd. VAGUS irritation/paralysis sd. CAUSIS ESOPHAGIAN DISEASES DESCENDENT AORTIC ANEURYSM NEUROGENIC TUMORS PULMONARY NEOPLASM

32. MEDIASTINAL SYNDROMES ACUTE MEDIASTINITIS ACUTE MEDIASTINAL SUPPURATION MEDIASTINAL ABSCESS MEDIASTINAL PLEURAL EFFUSION CLINICAL: PAIN INFECTIOUS sign DYSPNEA DYSPHAGIA

33. 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 CREPITATION

34. MEDIASTINAL SYNDROMES MEDIASTINAL HEMORRAGES AORTIC DISSECTION ANEURYSM RUPTURE COAGULOPATHIES