Summary
Anatomia mediastinal
O mediastino é o espaço torácico entre as pleuras viscerais dos pulmões. Os limites do mediastino são as pleuras viscerais, a entrada torácica (coluna vertebral, primeiras costelas e manúbrio), diafragma, esterno e ligamentos anteriores da coluna vertebral. O mediastino contém o coração, os grandes vasos, a traqueia, o esôfago, o timo, tecido linfático e nervos.
A classificação do International Thymic Malignancy Interest Group (ITMIG) divide o mediastino em compartimento pré-vascular, visceral e paravertebral (que estão levemente relacionados com os compartimentos históricos anterior, médio e posterior, respectivamente).[1][2]
[Figure caption and citation for the preceding image starts]: Compartimentos anatômicos do mediastino.Do acervo de Dr. Muniappan [Citation ends].
Conteúdo do mediastino
O conteúdo do mediastino pré-vascular (anterior) inclui:
Timo
Gordura mediastinal
Linfonodos
Aorta extracardíaca.
O conteúdo do mediastino visceral (médio) inclui:
Pericárdio, coração, aorta ascendente e descendente, grandes vasos
Traqueia e carina
Linfonodos
Esôfago
Nervos vagos
Duto torácico.
O conteúdo do mediastino paravertebral (posterior) inclui:
Vasos intercostais proximais
Gânglio espinhal torácico
Cadeia nervosa simpática
Linfonodos.
Differentials
Common
- Aneurisma aórtico torácico
- Linfoma não Hodgkin
- Câncer metastático
- Timoma
- Câncer pulmonar
Uncommon
- Dissecção da aorta
- Linfoma de Hodgkin
- Tumor mediastinal de células germinativas: seminoma
- Tumor mediastinal de células germinativas: não seminoma
- Carcinoma tímico
- Tumores de traqueia primários
- Tumor neurogênico
- Neoplasia de tireoide
- Bócio subesternal
- Leucemia linfocítica aguda (LLA)
- Leucemia linfocítica crônica
- Cisto pericárdico
- Cisto broncogênico
- Cisto esofágico (inclui cisto de duplicação esofágica)
- Tumor mediastinal de células germinativas: teratoma maduro
Contributors
Authors
Uma M. Sachdeva, MD, PhD
Assistant Professor of Surgery
Division of Thoracic Surgery
Massachusetts General Hospital
Harvard Medical School
Boston
MA
Disclosures
UMS declares that she has no competing interests.
Acknowledgements
Dr Uma M. Sachdeva would like to gratefully acknowledge Dr Ashok Muniappan, Dr John Kucharczuk, Dr Mario Gasparri, and Dr Nicholas Choong, the previous contributors to this topic. AM, JK, MG, and NC declare that they have no competing interests.
Peer reviewers
Marc Baker, MD, PhD
Cardiology Fellow
Department of Internal Medicine
Cardiology Division
University of Rochester
Rochester
NY
Disclosures
MB declares that he has no competing interests.
Abe DeAnda Jr., MD, FACS, FAHA
University Associate Professor
Cardiothoracic Surgery
Albert Einstein College of Medicine
Director Aortic Surgery
Montefiore Medical Center
Bronx
NY
Disclosures
AD declares that he has no competing interests.
Shahab A. Akhter, MD
Assistant Professor of Surgery
Section of Cardiac and Thoracic Surgery
The University of Chicago
Chicago
IL
Disclosures
SAA declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Carter BW, Benveniste MF, Madan R, et al. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017 Mar-Apr;37(2):413-36.Full text Abstract
Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive summary: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):7S-37S.Full text Abstract
American College of Radiology. ACR appropriateness criteria: imaging of mediastinal masses. 2020 [internet publication].Full text
Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl 5):e211S-50S.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Guidelines
- American College of Radiology ACR appropriateness criteria: imaging of mediastinal masses
- Managing incidental findings on thoracic CT: mediastinal and cardiovascular findings
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