The Mediastinum (2^nd Ed., 2nd ed. 1988. Softcover reprint of the original 2nd ed. 1988) Radiologic Correlations with Anatomy and Pathology

Over 10 years have passed since the first edition of The Mediastinum was published in 1977. I have been very gratified by the response to the first edition and determined to do a second edition as soon as possible. However, good intentions are sometimes difficult to achieve and a decade has passed. This period has been one of enormous growth in the discipline of diagnostic imaging. In the study of the mediastinum, computed tomog­ raphy, and more recently magnetic resonance, have revolutionized our diagnostic capabilities. This second edition of the mediastinum is in­ tended to emphasize the importance of these modalities to the evalua­ tion of mediastinal disease. In addition, an attempt will be made to integrate into the text the many new and important observations relat­ ing to all aspects of mediastinal imaging which have appeared in the literature since 1977. The overall emphasis, however, will remain the same: that accurate radiologic diagnosis is based upon a thorough understanding of corre­ lated radiographic anatomy and pathology. No matter what the imag­ ing modality, this principle remains fundamental to each and every radiographic interpretation. I would like to express once again my deep appreciation to Dr. Stephen A. Kieffer, Chairman of the Department of Radiology at the State University of New York Health Science Center at Syracuse for his continued support and encouragement.

1 Introduction.- 1.1 General Comments.- 1.2 An Anatomic Classification of the Mediastinum.- References.- 2 Preparation of Body Sections for the Study of Mediastinal Anatomy.- References.- 3 General Radiologic Considerations.- 3.1 Radiologic Examination of the Mediastinum.- 3.1.1 The Plain Film Examination.- 3.1.2 The Esophagram.- 3.1.3 Fluoroscopy.- 3.1.4 Conventional Tomography.- 3.1.5 Computed Tomography.- 3.1.6 Magnetic Resonance Imaging.- 3.1.7 Special Procedures.- 3.2 Factors Affecting the Demonstration of Mediastinal Anatomy and Pathology.- 3.2.1 The Lung-Mediastinum Interface.- 3.2.2 Mediastinal Fat.- 3.2.3 Mach Effect.- 3.3 Radiologic Characteristics of Mediastinal Masses.- 3.4 Lymph Nodes of the Mediastinum.- 3.4.1 Anatomy of the Lymph Nodes of the Mediastinum.- 3.4.2 Patterns of Metastatic Spread to Mediastinal Lymph Nodes.- 3.4.3 Significance of Mediastinal Lymph Node Metastasis in Carcinoma of the Lung.- 3.4.4 Radiologic Assessment of Metastases to Mediastinal Lymph Nodes.- 3.5 Connective Tissue Planes of the Mediastinum.- 3.5.1 The Perivisceral Fascia.- 3.5.2 The Prevertebral Fascia.- 3.6 Air in the Mediastinum.- 3.6.1 Pneumomediastinum.- 3.6.2 Paramediastinal Pneumatocoel.- 3.6.3 Pneumopericardium.- References.- 4 The Thoracic Inlet.- 4.1 General Anatomic Considerations.- 4.2 Radiologic Correlations with Anatomy and Pathology.- 4.2.1 Radiographic Anatomy at the Thoracic Inlet.- 4.2.2 The Thoracic Outlet Compression Syndrome.- 4.2.3 Intrathoracic Goiter.- 4.2.4 Mediastinal Parathyroid Adenoma.- 4.2.5 Spread of Infection Through the Thoracic Inlet.- 4.2.6 Mediastinoscopy.- 4.2.7 The Cervicothoracic Sign.- References.- 5 The Anterior Mediastinum.- 5.1 General Anatomic Considerations.- 5.1.1 Pleural Reflections of the Anterior Mediastinum.- 5.1.2 The Normal Thymus.- 5.2 Radiologic Correlations with Anatomy and Pathology.- 5.2.1 Collections of Fat in the Anterior Mediastinum.- 5.2.2 Anterior “Herniation” of Lung.- 5.2.3 Dilated Internal Mammary (Internal Thoracic) Arteries.- 5.2.4 Anterior Mediastinal Hematoma.- 5.2.5 Anterior Mediastinal Infection.- 5.2.6 Intrathoracic Goiter.- 5.2.7 Thymoma.- 5.2.8 Mediastinal Teratoma.- 5.2.9 Enlargement of Internal Mammary Lymph Nodes.- 5.2.10 Enlargement of Anterior Diaphragmatic (Cardiophrénie Angle) Lymph Nodes.- References.- 6 The Supra-aortic Area.- 6.1 General Anatomic Considerations.- 6.2 Radiologic Correlations with Anatomy and Pathology.- 6.2.1 The Supra-aortic Pleural Reflections.- 6.2.2 The Left Superior Intercostal Vein.- 6.2.3 Persistent Left Superior Vena Cava and Left Vertical Vein.- 6.2.4 The Aortic Bodies and Paraganglioma.- References.- 7 The Infra-aortic Area.- 7.1 General Anatomic Considerations.- 7.2 Radiologic Correlations with Anatomy and Pathology.- 7.2.1 The Aortic-Pulmonic Window.- 7.2.2 The Left Main Bronchus.- 7.2.3 The Preaortic Area.- 7.2.4 The Thoracic Duct.- 7.2.5 The Paraspinal Area.- 7.2.6 The Diaphragmatic Crura.- References.- 8 The Supra-azygos Area.- 8.1 General Anatomic Considerations.- 8.2 The Azygos Arch.- 8.2.1 Congenital Displacement of the Azygos Arch.- 8.3 The Prominent Azygos Vein.- 8.3.1 Aneurysmal Dilatation of the Azygos Arch.- 8.3.2 Azygos Vein Enlargement Secondary to Increased Right Ventricular Pressure.- 8.3.3 Azygos Vein Enlargement Due to Increased Blood Flow Through It.- 8.4 The Supra-azygos Recess.- 8.4.1 The Superior Vena Cava and Related Supra-azygos Vessels.- 8.4.2 The Right Paratracheal Line.- 8.4.3 The Paraesophageal Line.- 8.4.4 The Posterior Junction Line.- 8.5 The Paraspinal Line.- References.- 9 The Infra-azygos Area.- 9.1 General Anatomic Considerations.- 9.2 The Inferior Vena Cava.- 9.3 The Azygoesophageal Recess.- 9.3.1 The Right Pleuroesophageal Stripe.- 9.3.2 The Posterior Junction Line.- 9.3.3 Disease Distorting the Azygoesophageal Recess.- 9.3.4 The Prespinal Line.- 9.4 The Paraspinal Area.- References.- 10 The Pulmonary Hilum.- 10.1 General Anatomic Considerations.- 10.1.1 Vessels and Bronchi.- 10.1.2 Hilar Lymph Nodes.- 10.1.3 The Inferior Pulmonary Ligament.- 10.2 Radiologic Correlations with Anatomy and Pathology.- 10.2.1 Frontal Projection.- 10.2.2 Lateral Projection.- 10.2.3 Oblique Projection.- 10.2.4 Axial Projection.- References.