Mediastinal

Mediastinal refers to the mediastinum, the central compartment of the thoracic cavity between the lungs. The mediastinum extends from the superior thoracic aperture to the diaphragm and from the sternum to the vertebral column. It contains the heart and pericardial sac, great vessels, trachea, esophagus, thymus (especially in children), lymph nodes, and various nerves and connective tissues.

The mediastinum is classically divided into superior and inferior portions; the inferior is further subdivided into anterior, middle, and posterior compartments. The middle mediastinum houses the pericardial sac and heart, parts of the great vessels, and the main bronchi. The anterior mediastinum contains fat, connective tissue, and thymic remnants, while the posterior mediastinum contains the esophagus, thoracic aorta, thoracic duct, and descending veins.

Common mediastinal conditions include mediastinal masses (benign or malignant), mediastinitis, cysts, lymphadenopathy, and vascular or airways disorders. Symptoms may include chest pain, dyspnea, cough, hoarseness, or symptoms of vascular compression. Imaging—often chest radiography and computed tomography (CT)—is central to diagnosis. Magnetic resonance imaging (MRI) can help characterize soft tissue, particularly in younger patients or for pre-surgical planning.

Management depends on the underlying cause and may range from observation to biopsy, surgical resection, radiation, or chemotherapy. The mediastinum is clinically important because many critical structures traverse this space, and disease can affect breathing, circulation, or neural function.