Diseases of the mediastinum – surgical treatment

1. Big picture

The mediastinum is the central compartment of the thorax between the lungs. It contains the heart, great vessels, trachea, main bronchi, esophagus, thymus, thoracic duct, vagus nerves, phrenic nerves, recurrent laryngeal nerves, and lymph nodes. Because these structures are vital, mediastinal disease becomes surgical when it causes:

1. Compression
→ airway obstruction, dysphagia, superior vena cava syndrome

2. Invasion
→ great vessels, pericardium, lung, chest wall, nerves

3. Infection
→ acute mediastinitis, sepsis, esophageal perforation

4. Need for diagnosis
→ lymphoma, germ-cell tumor, metastatic lymph nodes

5. Curative resection
→ thymoma, teratoma, cyst, neurogenic tumor, selected localized tumors

The exam logic is:

Mediastinal mass
→ localize compartment
→ recognize likely diagnosis
→ assess danger: airway, SVC, sepsis, heart/great vessels
→ CT/MRI ± PET
→ biopsy if needed
→ resect, biopsy, drain, or treat medically depending on disease

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