15. Mediastinal Syndromes

MEDIASTINAL

SYNDROMES

MEDIASTINUM

TOPOGRAPHIC REGION THAT

SERVES AS A PASSING CHANNEL FOR

SOME ANATOMICAL ELEMENTS OF

VITAL IMPORTANCE

MEDIASTINUM

BORDERS

SUP THORACIC INLET T1 C1

LAT PLEURA

POST SPINE

ANT STERNUM

INF DIAPHRAGM

MEDIASTINUM- CONTENTS

RESPIRATORY system

DIGESTIVE system ESOPHAGUS

CARDIOVASCULAR system

TRACHEA

MAJOR BRONCHI

PLEURA

HEART

PERICARDUM

MEDIASTINUM - CONTENTS

ARTERIES

AORTA

BRACHIOCEPHALIC

LEFT COMMON CAROTID

LEFT SUBCLAVIAN

PULMONARY with his two branches

VEINS

SUPERIOR CAVA + 2 BRACHIOCEPHALIC

AZYGOS SYSTEM

INFERIOR CAVA

PULMONARY

ASCENDENT

ARCH: CONCAVITY, CONVEXITY

DESCENDENT


LYMPHATICS

THORACIC DUCT

LYMPH NODES

ANTERO-SUPERIOR group

MIDDLE group

POSTERIOR group


NERVES

VAGUS (POSTERIOR MEDIASTINUM)

LEFT RECURRENT LARYNGEAL

RIGHT RECURRENT LARYNGEAL

PHRENICS

ANTERIOR MEDIASTINUM

OVER THE LEFT VENTRICLE

SYMPATHETICS CHAINS

INTERCOSTALS


ENDOCRINE glands

THYMUS

THIROID

PARATHYROIDS

ADIPOSE AND CONJUNCTIVE TISSUE

MEDIASTINUM COMPARTMENTS

ANTEROSUPERIOR (VASCULAR and GLANDULAR)

TRACHEA

THYMUS

AORTIC ARCH

GREAT ARTERIES

SUPERIOR CAVA

AZYGOS/HEMIAZYGOS V.

SUPERIOR MEDIASTINAL LYMPH NODES

THYROID, PARATHYROIDS

CONJUNCTIVE TISSUE

MEDIASTINUM COMPARTMENTS

MIDDLE (VISCERAL)

HEART (PERICARDUM)

ASCENDENT AORTA

CONCAVITY OF THE AORTIC ARCH

LEFT RECURRENT LARYNGEAL NERVE

TRACHEA and its BIFURCATION

MAJOR BRONCHI

PULMONARY VEINS

PARATRACHEAL LYMPH NODES

MEDIASTINUM COMPARTMENTS POSTERIOR (PARAVERTEBRAL)

ESOPHAGUS

VAGUS NERVE

THORACIC DUCT

ASCENDENT AORTA

SYMPATHETICS CHAINS

POSTERIOR MEDIASTINAL LYMPH NODES

INTERCOSTAL NERVES

MEDIASTINUM SEMIOLOGY

RESPIRATORY

DYSPNEA CONTINOUS, INSPIRATORY (trachea, bronchi)

PAROXISMAL

ASTHMA-like (vagus)

LARYNGOSPASM (recurrent laryngeal)

COUGH

DRY

BITONAL

VOICE CHANGES

HOARSENESS (DYSPHONIA), BITONAL

APHONIA

RATIONAL SYMPTOMS and SIGNS


DIGESTIVE

DYSPHAGIA

PERSISTENT kalc devaml (COMPRESSION)

INTERMITENT kesik kesik,aralkl(VAGUS)

ESOPHAGEAL EMESIS (VOMITING)

CARDIAC

RHYTHM DISTURBANCES(VAGUS)

PERICARDITIS

pericarditis Inflammation of the pericardium, the membrane that

surrounds the heart

VASCULAR

ARTERIAL

AORTIC PULSATION in STERNOCLAVICULAR AREA

DIMINISHED/ABOLISHED RADIAL PULSE (subclavian compression)

PULSUS PARADOXUS (aortic compression)

OLIVER CARDARELLI sign

ARTERIAL MURMURS


VASCULAR

VENOUS

SUPERIOR CAVA VEIN OBSTRUCTION

VENOUS HYPERTENSION HEADACHE

LETHARGY

EPISTAXIS burun kanamas

SWELLING and CYANOSIS of FACE, NECK, ARMS

MARKED COLLATERAL CIRCULATION

JUGULAR VEINS DISTENSION

VENOUS STASIS

BRACHIOCEPHALIC VEIN OBSTRUCTION

RETINIAN STASIS

IPSILATERAL SWELLING


SUPERIOR CAVA VEIN COMPRESSION SYNDROME

VASCULAR

VENOUS

INFERIOR CAVA VEIN COMPRESSION

LOWER LIMBS SWELLING

HEPATOMEGALY, ASCITIS

PULMONARY VEINS COMPRESSION

PULMONARY STASIS

HEMOPTYSIS

HYDROTHORAX

AZYGOS VEIN COMPRESSION

RIGHT HYDROTHORAX

LYMFATICS

THORACIC DUCT COMPRESSION CHYLOTHORAX


ENDOCRINE

INTRATHORACIC GOITER HYPO/HYPERfunction

PARATHIROID HYPERPARATHIROIDISM

THYMUS MIASTENIA GRAVIS

CONJUNCTIVE TISSUE

SUPPURATIONS

PNEUMOMEDIASTINUM


INTRATHORACIC GOITER

NERVES

PAIN

1. LOCALISATION: RETROSTERNAL, INTERSCAPULARVERTEBRAL

2. RADIATION: ANTERIOR CERVICAL

3. DURATION: PERSISTENT devaml (from 0 to extreme)

4. INTENSITY: VARIABLE

5. DEBUT is INSIDIOUS

6,7. influenced by the intrathoracic pressure changes


NERVES


IRITATION PARALYSIS

VAGUS

BRONCHOSPASM

ESOPHAGIAN SPASM

BRADYCARDIA

TACHYCARDIA

PHRENIC HICCUPS DIAPHRAGM

HYPOTONIA

NERVES

INTERCOSTAL NEURALGIA

CERVICAL SYMPATHETIC CHAIN lesion

sd. CLAUDE-BERNARD-HORNER

MIOSIS

PALPEBRAL PTOSIS

ENOPHTALMOS

CERVICO BRACHIAL NEURALGIA


CLINICAL EXAMINATION FINDINGS

INSPECTION

ADENOPATHIC THORAX

RETRACTION

COLATERALL CIRCULATION

JUGULAR VEINS DISTENSION

SWELLING

PALPATION

SENSIBILITY

PECTORAL FREMITUS CHANGES


MODIFICARI LA EXAMENUL OBIECTIV

PERCUTION

PARAMANUBRIAL DULLNESS

INTERSCAPULARVERTEBRAL DULLNESS

C7 T4 DULLNESS

AUSCULTATION

LOCALISED DIMINISHED/ABOLISHED BREATH SOUNDS

BRONCHIAL SOUND

VERTEBRAL BRONCHOPHONY

PECTORILOQUI


RADIOLOGY and COMPUTED TOMOGRAPHY

Establish the diagnostic

WIDENED mediastinal shadow (esp. in the superior region)

- CAN BE:

REGULAR: MEDIASTINITIS (fine layers)

IRREGULAR: TUMORS (usually polycyclic)

In some particular situations:

Expanded tumor related to the aorta: AORTIC ANEURYSM

Polycyclic shadows: LYMPHADENOPATHIES

TUMOR, ATELECTASIA: PULMONARY CANCER

RISING WHEN SWALLOWING: INTRATHORACIC GOITER

PRINTING THE ESOPHAGUS

COMPUTED TOMOGRAPHY the most reliable examination


WIDENED MEDIASTINUM

MEDIASTINAL LYMPHADENOPATHY

MEDIASTINAL SYNDROMES

ANTERO-SUPERIOR MEDIASTINAL Sd.

SUPERIOR CAVA VEIN Sd.

BRACHIOCEPHALIC VEIN Sd.

CAUSIS

SUPERIOR PULMONARY LOBE NEOPLASM

AORTIC ARCH ANEURYSM

INTRATHORACIC GOITER

THYMOMA

LYMPHOMAS

MEDIASTINAL ABCESSES


MIDDLE MEDIASTINAL Sd.

BRONCHO-RECURRENTAL

AORTIC ARCH ANEURYSM

CAUSIS

BRONCHOPULMONARY CANCER

METASTASIS

LYMPHOMA


POSTERIOR MEDIASTINAL Sd.

ESOPHAGIAN disorders

CLAUDE-BERNARD-HORNER sd.

VAGUS irritation/paralysis sd.

CAUSIS

ESOPHAGIAN DISEASES

DESCENDENT AORTIC ANEURYSM atardamar

genilemesi

NEUROGENIC TUMORS

PULMONARY NEOPLASM


ACUTE MEDIASTINITIS

ACUTE MEDIASTINAL SUPPURATION

MEDIASTINAL ABSCESS

MEDIASTINAL PLEURAL EFFUSION szma

CLINICAL:

PAIN

INFECTIOUS sign

DYSPNEA nefes darl

DYSPHAGIA yutkunma zorluu


PNEUMOMEDIASTINUM (mediastinal emphysema)

Introduction of air from esophagus, tracheobronchial tree, neck, or abdomen

Causes: penetrating or blunt trauma, or spontaneous mediastinal emphysema

CLINIC:

SUBSTERNAL CHEST PAIN

DYSPNEA nefes darl

CREPITATION


MEDIASTINAL HEMORRAGES

AORTIC DISSECTION

ANEURYSM RUPTURE

COAGULOPATHIES Phtlama bozukluu, kann phtlamasnda

bozukluk ile belirgin herhangi bir durum

15. Mediastinal Syndromes

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