Grouping of Lymph Nodes: Lymph nodes were grouped and numbered according to the revised criteria of Japanese Society for Esophageal Diseases.9 Cervical lymph nodes were divided into 101, 102, 103 and 104 groups, lymph nodes in the upper mediastinum were divided into 105, 106rec, 106pre and 106tb groups, those in the middle mediastinum
were divided into 107, 108, 109 and 112 groups, those in the lower mediastinum were divided into 110 and 111 groups, and those in the abdominal cavity were divided into 1~11 groups.
For tension and pitch there were higher means in the group of subjects with tumors located in the middle mediastinum
, as Table 2.
Patients, who underwent surgery for lesions localized in the posterior or middle mediastinum
, were placed in lateral decubitus position slightly tilted anteriorly.
They typically present in the middle mediastinum
, representing approximately 33% of mediastinal cysts and 6-7% of mediastinum masses .
Thoracic computed tomography (CT) scan and angiogram showed a soft tissue mass in the middle mediastinum
, compressing the carina and proximal part of the right and left main bronchi, more pronounced on the left main bronchus (Figure 2).
The most common mediastinal cysts include bronchogenic cysts, enteric duplication cysts, pericardial cysts, and thymic cysts, though most of these cysts appear in the middle mediastinum
with the exception of thymic cysts in the anterior mediastinum.
The masses were located in the anterior mediastinum in 8 (53%) patients, 6 (40%) cases had posterior mediastinal masses and one patient was with a mass in anterior & middle mediastinum
There are three potential pathways for spread of a neck infection into the mediastinum: 1) The pretracheal route to the anterior mediastinum, 2) The lateral pharyngeal route to the middle mediastinum
, and 3) The retropharyngeal-retro-visceral route to the posterior mediastinum (12).
Computed tomography (CT) angiography revealed no evidence of a pulmonary embolus, but did show several enlarged (up to 3.5 cm in diameter) lymph nodes in the upper and middle mediastinum
Other common lesions were tubercular lesions like in anterior mediastinum adenopathy (four), middle mediastinum
adenopathy (two), and paravertebral abscesses (three) in posterior mediastinum.
However, the percutaneous approach to some metastatic lymph nodes in the middle mediastinum
is difficult or impossible due to their closeness to the aorta, superior vena cava (SVC), trachea, and esophagus without enough space for the safe passage of the needle.
At the time of diagnosis, the bulk of his extramedullary disease was in the chest, primarily involving the anterior and middle mediastinum
. The patient was successfully treated with radiation, chemotherapy, and double umbilical cord blood transplant, with complete response to therapy.