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CORE: Thoracic > Mediastinum > Flashcards

Mediastinum Flashcards

1
Q

mediastinal compartments

A

anterior: prevascular and precardiac anterior mediastinum (sternum/pericardium, ascending aorta)
middle: (heart and posterior tracheal wall)
posterior: (posterior trachea and posterior pericardium)

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2
Q

contents of anterior mediastinum

A

thymus, lymph nodes, thyroid gland if it extends inferiorly

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3
Q

middle mediastinum contents

A

heart, ascending aorta/arch, great vessels, trachea/bronchi, LN, phrenic/vagus/recurrent laryngeal nerves (pass through AP window)

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4
Q

posterior mediastinum

A

esophagus, descending thoracic aorta, azygos/hemiazygos, thoracic duct, vagus nerve, LN

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5
Q

define: line, stripe, interface on CXR

A

line: interface of tissue with air on both sides
stripe: air and adjacent soft tissues
interface: contact of two soft tissue structures of different densities

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6
Q

anterior junction line

A

4 layers of pleura between R/L lung, anterior junction

projects over superior 2/3 of sternum

abnormality suggests anterior mediastinal mas

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7
Q

posterior junction line

A

4 layers of pleura between R/L lung, anterior junction

projects through trachea; above clavicles

abnormality: posterior mediastinal mass/aortic aneurysm

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8
Q

paratracheal stripes

A

pleura where medial aspect of lung abuts trachea

abnormal R paratracheal stripe: pleural thickening, or paratracheal mass/thyroid

abnormal L paratracheal stripe: as above + mediastinal hematoma

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9
Q

posterior tracheal stripe

A

posterior wall of trachea and pleura of medial R lung

seen only on lateral radiograph

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10
Q

paraspinal lines

A

interfaces that appear as lines abutting posterior mediastinum

abnormal: posterior mediastinal mass–hematoma, neurogenic tumor, aortic aneurysm, extramedullary hematopoiesis, esophageal mass, osteophyte

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11
Q

azygoesophageal recess

A

posteromedial RLL and retrocardiac mediastinum

abnormal: esophageal mass, hiatal hernia, left atrial enlargement, LN

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12
Q

AP window

A

bound by aortic arch and top of pulmonary artery as well as esophagus/trachea/left mainstem bronchus

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13
Q

abnormal bulging of AP window ddx

A

LN, left phrenic nerve, recurrent laryngeal nerve, left vagus nerve, ligamentum arteriosum, left bronchial arteriosum, thoracic aortic aneurysm

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14
Q

retrosternal space

A

lateral radiograph, anterior mediastinum

obliteration: mass, RV dilation, pulmonary artery enlargement
increased: emphysema

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15
Q

aortic nipple

A

left superior intercostal vein

small round shadow to the left of the aortic knob on AP

may dilate in SVC obstruction

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16
Q

hilum overlay sign

A

hilar vessels visualized through mass

mass must be in anterior/posterior mediastinum, NOT middle

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17
Q

localizing mass to anterior mediastinum on XR

A

hilum overlay sign

obliteration of retrosternal clear space

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18
Q

localizing middle mediastinal mass

A

distortion of paratracheal stripes

convexity of AP window

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19
Q

localizing posterior mediastinal mass on XR

A

distortion of azygoesophageal recess, posterior junction line, displacement of paraspinal lines

20
Q

anterior mediastinal mass

A

thymoma/thymic epithelial neoplasm, teratoma/germ cell tumor, thyroid, terrible lymphoma

21
Q

thymoma

A

45-60yo, associated with myasthenia gravis

also associated with red cell aplasia, hypogammaglobulinemia, paraneoplastic syndrome, malignancy

22
Q

considerations for thymoma

A

intact capsule, invasion

invasion into airways, chest wall, great vessels, phrenic nerve

check for elevation of hemidiaphragm

drop mets to pleural/pericardial surfaces

23
Q

thymic carcinoma

A

poor prognosis, aggressive and mets to lungs, liver, brain, bone

24
Q

thymic carcinoid

A

neural crest origin; hormonally active and can secrete ACTH (cushings)

associated with MEN I/II

scan with In-111 octreotide

25
Q

thymic cyst

A

secondary to radiation therapy (Hodgkin), AIDS (multilocular), or congenital (thymopharyngeal duct)

26
Q

thymolipoma

A

fat lesion interspersed with soft tissue

27
Q

germ cell tumor (anterior mediastinum)

A

teratoma and seminoma

most are benign although malignant GCT usually in males

28
Q

most common anterior mediastinal germ cell tumor

A

teratoma

29
Q

teratoma imaging features (anterior mediastinum)

A

encapsulated, cystic with fat/calcifications; may be malignant if large and irregularly shaped

30
Q

seminoma

A

most common malignant mediastinal germ cell tumor

exclusively in men

31
Q

thyroid lesions

A

goiter, thyroid neoplasm, thyroiditis

32
Q

mediastinal mass: lymphoma

A

HL and NHL

superior mediastinal nodes involved: prevascular, AP, paratracheal

33
Q

non-lymphomatous adenopathy

A

silicosis, coal workers pneumoconiosis, sarcoidosis, active TB, fungal infection, Castleman disease, vascular mets (RCC, thyroid, lung sarcoma, melanoma)

34
Q

Castleman disease

A

angiofollicular lymph node hyperplasia; vascular thoracic lymph node enlargement

children/young adults OR older patients/AIDS

systemic disease: fevers/anemia/lymphoma

treat: surgical resection and chemotherapy for systemic dx

35
Q

epicardial fat pad

A

silhouettes cardiac border on frontal radiograph; may look like cardiomegaly

36
Q

pericardial cyst

A

benign cystic lesion at right CP angle

37
Q

morgagni hernia

A

diaphragmatic hernia through foramen of Morgagni containing omental fat/bowel; right side

38
Q

middle mediastinal masses

A

lymphadenopathy, ascending aortic arch/aneurysm, enlarged PA, foregut duplication cyst

39
Q

hilum convergence sign

A

peripheral pulmonary arteries converge into a “mass”

40
Q

foregut duplication cysts

A

bronchogenic cysts, esophageal duplication cyst, neurenteric cyst

41
Q

posterior mediastinal mass

A

neurogenic tumor, hiatal hernia, descending TAA, extramedullary hematopoiesis, lateral meningocele , esophageal neoplasm, foregut duplication cyst, paraspinal abscess

42
Q

neurogenic tumors: PNS and SNS

A

peripheral nerve tumors (adults): schwannoma, neurofibroma, malignant peripheral nerve sheath tumor

sympathetic ganglion tumor (peds): ganglioneuroma, neuroblastoma, ganglioblastoma

43
Q

posterior mediastinal mass: hiatal hernia XR

A

air fluid level above diaphragm

44
Q

posterior mediastinal mass: extramedullary hematopoeisis

A

soft tissue paravertebral mass in pts with severe hereditary anemia or thalassemia/sickle cell

may represent herniation of vertebral marrow or elements of reticuloendothelial system

bilateral and inferior to T6

45
Q

posterior mediastinal mass: lateral meningocele

A

herniation of spinal meninges through intervertebral foramen or vertebral body defect; associated with NF

CORE: Thoracic (11 decks)

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