Nov 15, 1981 - on the mediastinum. Carl. J. Zylak, ... conceive the mediastinum ..... Zylak, et at. CT of the mediastinum. Unknown. Primary. Carcinoma. Figure.
THIS EXHIBIT, IENTIFIC
A SELECTION OF THE ASSEMBLY AND ANNUAL AMERICA,
CHEST RADIOLOGY MEETING OF THE
NOVEMBER
15-20,
1981,
CHICAGO,
Correlative
anatomy
computed
tomography:
A module
on the mediastinum
Carl
J.
w.
Pallie,
Zylak,
Rodger
SOCIETY
ILLINOIS.
and
M.B.t M.B.*
To facilitate
the
interpretation
the mediastinum
longitudinal
of sectional to be divided
compartments
the diaphragm: 3,
AT THE 67TH OF NORTH
DISPLAYED
M.D.*
Jackson,
conceive
PANEL, WAS RADIOLOGICAL
from
space;
,
the postvascular
into
extending
1 the prevascular
images,
2,
three the
the
the
authors
uninterrupted thoracic
inlet
vascular
to and
space;
space.
Thoracic CT scan images are usually correlated with atlases representing cadavenc anatomy. They often fail to address the task of interpreting specific aspects
of living In order
select
anatomy to facilitate
morphological
as recorded
in computed
this
the
schemata
process,
or line
tomographic
following
diagrams
are
sections.
presented
superimposed
here:
radiographic
images
with
pathological
2, Number
4
November
recon-
correlations.
From the Departments of Radiology (*) and Anatomy (t) Medical Centre, Hamilton, Ontario. Address reprint requests to C. J. Zylak, M.D., Department University Medical Centre, Hamilton, Ontario, L8N 3Z5.
Volume
1,
on normal
chest radiographs; 2, normal CT images with anatomical interpretation inforced with selected cadaveric sections; and 3, abnormal CT and ventional
Introduction
McMaster
University
of Radiology,
1982
and
McMaster
RadioGraphics
555
Zylak, CT
The
Morphologic Concepts
et at.
of the mediastinum
and
traditional
inferior
tenor
The
represents
approach into
the level Figure
taken
thoracic (M)
pencardium
and
branches
which
(4) that
the
of the
and
Figure
the
RadioGraphics
and for
posuse
in
the into
neck.
and
trachea
The
being from
the
aorta
and
mediastinal
into The
contains
space
mediastinal
incorporates
anterior
continues
and
middle that
anterior
parathyroids. This
space and
the
The
space,”
vein.
mediastinum
uninterruptedly
space”
veins,
space,”
thyroid azygos
proposed.
great
the
of the
of the diaphragm.
the neck posterior
the
so-called
in a plane mediastinal
trachea,
continues
into
esophagus,
the neck
“perivisceral
1
November
1982
Volume
of the mediastinum
2, Number
4
the its major compart-
esophagus.
Diagram demonstrating separation 3 longitudinal compartments.
556
superior
middle
is unsatisfactory
concept
a “vascular
its contents,
retropharyngeal
includes
into
anterior,
extending
scheme
is exclusively
is, the “prevascular
aorta
the
to the level
(P) or “postvascular
descending plane
favors
inlet
the thymus,
compartment
that
compartments
continue
(A); that includes
into
a scheme
here
1 represents
compartment
divided
(1-3).
3 longitudinal
of the
of the mediastinum
the latter
interpretation
divided
that
with
compartments,
radiologic
ment
compartmentalization
divisions
into
in the space”
Zylak, CT
NORMAL
These normal
chest
line
diagrams
the
Figure 2A The structures
sectional
the
structures,
topographic
representations
superimposed relationships
at selected
on that
levels
help
through
thorax.
Figure 2B The aorta have been
of the posterior
mediastinal compartment are shown; namely, the esophagus with the azygos vein on its right and the trachea and main bronchi lying anteriorly. The descending aorta and thoracic
duct
thoracic
present
cross
mediastinum
ANATOMY
of selected
radiographs,
one to interpret.the
of the
et al.
these
tenor
and great vessels added. Note that vessels lie in a plane anto the trachea.
Figure 2C The great veins have been superimposed. The great vessels shown in Figures 2B & C and the heart, represent the middle mediastinal compartment or the “vascular space.”
are not depicted.
.51
Figure
2D
The pulmonary in situ.
Figure The
artery
is shown
2E
orientation nary veins and depicted.
of the pulmothe left atrium is
Figure
Volume
2D
2, Number
4
November
Figure
2E
1982
RadioGraphics
557
Zylak, CT
et at.
of the
mediastinum
NORMAL
ANATOMY
.5
Figures Schematic
3A
& B
drawings
of right
(A) and
Figures
the thorax. and levels
558
(B) parasagittal
4 through
Each
a corresponding 1 through
RadioGraphics
left
sections
1 1 represent
of these cross
figures
successive
includes
section
of the
transverse
a CT section,
of a cadaver.
8 indicated
in Figures
November
1982
thorax.
3A
Volume
These and
B.
2,
Number
sections
an annotated figures
4
through
diagram
correspond
to
Zylak, CT
NORMAL
of the
et al.
mediastinum
Level
ANATOMY
Base
of Heart
Dome
of Right
Hemidiaphragm
Figure
4A
Figures
4A, B & C the clear delineation of the anterior pericardium, the cardiac chambers and the relationship of the coronary sinus and inferior vena cava. Note
Figure
4B
KEY
ah Ao AtR
CS
=
D Es
=
IVC
=
Fe yR
VL
Figure
Volume
2, Number
4
November
1982
x
4C
RadioGraphics
=
hemiazygos vein aorta right atrium coronary sinus dome of right hemidiaphragm esophagus inferior vena cava pericardium right ventricle left ventricle xiphoid
559
1
Zylak, CT
et at.
of the
mediastinum
Level 2 Left Atrium
NORMAL
Figure
Figures
5A, B
Both atria
SA
& C
are shown
the root of the aorta
outflow
ANATOMY
together and
with
pulmonary
tract.
Figure
SB
KEY
AJL
=
Ao At” AtL
PA PVL
560
= =
anterior junction line aorta right atrium left atrium pulmonary artery left pulmonary vein
Figure
RadioGraphics
SC
November
1982
Volume
2, Number
4
Zylak, CT
NORMAL
of the
et at.
mediastinum
Level 3 Right
ANATOMY
Pulmonary
Artery
Figure
Figure The and
6A
6A, B
& C
right pulmonary superior vena
artery, aorta cava are in-
trapericardial here. Note the antenor relationship of the left superior pulmonary vein to the bronchus.
Figure
6B
KEY
a
azygos
Ao
B
Figure
Volume
2, Number
4
November
1982
6C
RadioGraphics
BLL BUL Es PA PAR pyL
= = =
=
aorta bronchus lower left upper left esophagus
bronchus bronchus
pulmonary artery right pulmonary artery left
pulmonary
vein
561
Level
Zytak,
et al.
CT
the mediastinum
of
4
NORMAL
ANATOMY
Left Pulmonary Artery and Carina
Figure
7A
-
--
LI T
Figures 7A, B & C Small branches arising from the left pulmonary artery are seen on the CT scan. The relationship of the azygos, aorta and esophagus is
shown.
Figure
7B
KEY
a
azygos
AJL Ao Es
=
N
=
S
=
anterior junction aorta espohagus lymph nodes sternum
=
superior
SVC
562
vena
line
cava
Figure
RadioGraphics
7C
November
1982
Volume
2, Number
4
Zylak,
CT
NORMAL
of
et at.
the mediastinum
Level
ANATOMY
Azygos
Figure
5
Arch
8A
Figures 8A, B & C The azygos arch is seen
ing Note
the
superior
the
enter-
vena
small
lymph
cava. nodes
lying within fat anterior to the trachea. This space is readily accessible to the mediastinoscope.
Figure
8B
-
KEY
,&
a
I .
r
AJL Ao
.
Es N
#{149}
Figure
Volume
2, Number
4
November
1982
RadioGraphics
8C
SVC T
azygos =
anterior aorta
junction
line
esophagus = = =
lymph nodes superior vena trachea
cava
563
Zylak, CT
Level
et at.
of the
mediastinum
6
Aortic
NORMAL
ANATOMY
Arch
II
Figure
Figures
9A,
B & C
The superior cava is lateral aortic arch.
to the
Z’(j
I
Cl
9A
vena
Figure
9B
KEY
a AOA
Es N
=
azygos aortic
=
lymph
I,
arch esophagus nodes
S = sternum SVC T
564
= =
superior trachea
vena
cava Figure
RadioGraphics
9C
November
1982
Volume
2, Number
4
Zylak, CT
NORMAL
of the
et at.
mediastinum
Level Brachiocephalic
ANATOMY
7
Vessels
Figure
lOA
Figures
Five
seen
1OA,
vessels
B & C
are
cut in cross-
section.
Figure
lOB
KEY
BCA BCV BCVR BCVL LCC LSA PM Figure
S T
hOC
Volume
2, Number
4
November
1982
RadioGraphics
= =
brachiocephalic artery brachiocephalic vein right branch of brachiocephalic left branch of brachiocephalic
=
left
=
left subclavian
=
pectoralis
=
sternum trachea
=
common
vein
vein
carotid artery artery
major
muscle
565
Zylak, CT
Level
et al.
of the
rnediastinum
8
NORMAL
ANATOMY
Sternoclavicular Joint (upper
manubrium)
Figure
llA
Figures hhA, B & Six vessels are seen in cross section.
Figure
C
11B
KEY
BCVL BCVR
=
left brachiocephalic right brachiocephalic esophagus
=
left
=
left subclavian left lung
=
Es LCC LSA LuL Lu1 Pm PM RCC RSA
S St.H. T
566
common
vein
vein
carotid artery artery
right lung pectoralis
minor
muscle
=
pectoralis
major
muscle
= =
right right
common
subclavian
=
sternum
=
sternohyoid
=
trachea
carotid
artery
artery
Figure
RadioGraphics
llC
November
1982
Volume
2, Number
4
Zytak, CT
PATHOLOGY:
ANTERIOR
MEDIASTINAL
(PREVASCULAR
Figure
COMPARTMENT
with
demonstrates on the right
widening side.
of the
l2B
Conventional mediastinum.
Figure l2C CT scan confirms that the mediastinal widening represented on the conventional tomogram shown outlined by fat (A).
Volume
2, Number
Mediastinal Fat
Figure
radiograph undulation
et al.
mediastinum
SPACE)
l2A
A posteroanterior mediastinum
of the
4
November
1982
tomogram
is due to fat. in B represents
RadioGraphics
depicts
an edge
(arrows)
within
the
The edge the aorta
567
Zylak, CT
et al.
of the mediastinum
Thyroid Adenoma
PATHOLOGY:
ANTERIOR
MEDIASTINAL
(PREVASCULAR
COMPARTMENT
SPACE)
:;‘
I
Figure
Figure
13A
The large the right.
mass
compresses
and displaces
the trachea
to
13B
CT scan caudad cular anatomy.
to the mass
demonstrates
normal
,
I .
,
#{128}j :‘:
.7
.,‘
/4
Figure
The
13C
mass with calcification lies anterior Note the tracheal compression.
568
to the
RadioGraphics
vessels.
November
Figure 13D The mass is seen
1982
Volume
continuing
2, Number
into
4
the neck.
vas-
Zytak, CT of
et al.
the mediastinum
Dermoid
Figure
l4B
Figure
l4A
A posteroanterior asymptomatic large anterior present. Note
Figure
l4C
Figures h4B, C & D The mass in the prevascular
of the right calcification
Volume
2, Number
4
November
1982
radiograph of an 67 year old man. A mediastinal mass is the normal posterior
junction line (arrows). radiograph showed
The lateral an anterior
mass displacing teriorly.
trachea
space
extends
atrium to the mid manubrium. in its wall and contains fat.
RadioGraphics
the
from
the
pos-
level
The mass has
569
Zylak, CT
et al.
of the
Pericardiat
mediastinum
PATHOLOGY:
MIDDLE
Cyst
MEDIASTINAL
(VASCULAR
Figure
COMPARTMENT
SPACE)
1SA
This posteroanterior radiograph demonstrates a mass lateral margin in the right cardiophrenic angle.
Figure
a sharp
l5B
On the CT scan the mass firmed at surgery.
570
with
RadioGraphics
is of water
November
density.
1982
The
Volume
presence
of a pericardial
2, Number
4
cyst
was con-
Zylak, CT
PATHOLOGY:
MIDDLE
MEDIASTINAL
(VASCULAR
et at.
of the mediastinum
Right
COMPARTMENT
SPACE)
Aortic Arch
3
Figure
h6A
This posteroanterior mediastinum.
Figure radiograph
shows
widening
of the
l6B
The lateral radiograph nor wall of the trachea.
shows
indentation
of the poste-
KEY
1, descending
aorta;
2,
mediastinal
fat; 3, superior
vena
cava.
-w
2 S
.4
Figure
16C
This CT scan demonstrates posterior to the trachea.
Figure
the right
Volume
aortic
2, Number
arch
crossing
4
November
h6D
A more caudad scan shows the descending aorta to be on the left (1). Mediastinal fat accounts for the left edge (2) and the superior vena cava for the right edge (3) on the posteroanterior radiograph.
1982
RadioGraphics
571
Zylak, CT
Aberrant
et at.
of the mediastinum
Right
PATHOLOGY:
MIDDLE
Subclavian
MEDIASTINAL
(VASCULAR
COMPARTMENT
SPACE)
Artery
Figure
17A
Figure
This conventional anteroposterior a tubular structure arising from traversing to the right.
Figures h7C This sequence posterior
572
tomogram shows the aortic arch and
h7B
The lateral radiograph, shows indentation posterior wall of the trachea and obliteration superior margin of the aorta by a soft mass.
& D
to the
of CT scans trachea.
demonstrates
an aberrant
RadioGraphics
right
subelavian
November
artery
1982
arising
Volume
from
the aortic
2, Number
4
arch
and crossing
of the of the tissue
Zytak, CT
PATHOLOGY:
MIDDLE
MEDIASTINAL
(VASCULAR
3
of
et at.
the mediastinum
Aneurysmat
COMPARTMENT
SPACE)
Dilatation
of Left
Subctavian
Artery
5
2
S
I Figure
18A
Figure
The
posteroanterior
with
Hodgkin’s
mediastinum
radiograph
disease (arrow
the mediastinal
of a 60 year
demonstrates 1). Mediastinal
line 4 are explained
widening
old
man
of the
edges 2 and 3 and by the following CT
This lated
l8B CT scan above atherosclerotic
posterior
junction
the aortic arch left subelavian
line is clearly
demonstrates a diartery (1). The shown (4).
sections.
Figure
h8C
Figure
At this level,
the superior
vena
right
mediastinal
edge.
lateral
Volume
cava
(3) accounts
2, Number
4
for the
November
l8D
On the scan below the carina, right side of the descending astinal edge (2).
1982
RadioGraphics
the right lung contacts the aorta and explains medi-
573
Zylak, CT
et at.
of the mediastinum
Postcoarctation
PATHOLOGY:
MIDDLE
Repair
Figure
19A
Figure
This 29 year old man had undergone surgical repair of a coarctation 20 years previously. Some difference in arterial pressures and flow between upper and lower extremities was still present. Details of the surgery were not available, but it was assumed that he had an homologous graft. The PA film demonstrates a prominent left subelavian artery and change in caliber of the descending aorta (arrow).
Figure 19C This CT scan corresponds to the stenotic segment of the descending at the site of the graft (arrowhead).
574
MEDIASTINAL
(VASCULAR
level of a calcified aorta presumably
RadioGraphics
November
This
COMPARTMENT
SPACE)
19B
CT
subelavian
scan
demonstrates
artery
Figure 19D This more caudal scan caliber of the descending
1982
Volume
enlargement
of the
left
(arrowhead).
demonstrates a more aorta (arrowhead).
2, Number
4
normal
Zylak, CT
PATHOLOGY:
MIDDLE
MEDIASTINAL
(VASCULAR
mediastinum
Anomalous
COMPARTMENT
Veins
SPACE)
Figure Figure
of the
et at.
20B
20 A
A “routine” chest radiograph old man shows a paravertebral left.
of this 19 yearmass on the
4.
*4
Figure
&1
-
#{163}
Figures ZOB, C & D This sequence of CT scans
20C
The arch of the azygos enlarged
Volume
2, Number
4
November
paravertebral
1982
demonstrates
a large azygos vein (1). the size of the aorta, and are also present (3).
vein (2) is almost
RadioGraphics
veins
575
Zytak,
et at.
CT
the mediastinum
of
Unknown
PATHOLOGY:
POSTERIOR
MEDIASTINAL
(POSTVASCULAR
Primary
COMPARTMENT
SPACE)
Carcinoma
Figure
21A
A posteroanterior chest radiograph of this 56 year old man shows a mass in the right cardiophrenic region (1), a localized bulge (2) at the level of the azygos
vein
and a left pleural
Figure A barium pressed
576
F
effusion.
2lB swallow
shows
the
esophagus
to be com-
anteriorly.
RadioGraphics
November
1982
Volume
2, Number
4
Zylak, CT
of
et at.
the mediastinum
Unknown Primary
Carcinoma
Figure
21C
On this CT scan, an enlarged displaces the superior vena
Figure
21D
A large
mass
the left atrium
Figure
(m) displacing
is clearly
node anterior cava (arrow)
the esophagus
evident
to the trachea laterally.
and
indenting
on this CT scan.
ZhE
On the most caudal mass (1) is lateral
CT scan the border of the posterior to the inferior vena cava. Note the prominence of the hemiazygos vein. A large, right pleural effusion is present despite a normal appearing costophrenic angle. Fluid is present in the left major fissure.
Volume
2, Number
4
November
1982
RadioGraphics
577
Zylak, CT
et at.
of the
Lymphoma
mediastinum
PATHOLOGY:
POSTERIOR
MEDIASTINAL
(POSTVASCULAR
.
Figure
S
22A
Paravertebral old man with
Figure
COMPARTMENT
SPACE)
widening lymphoma.
is evident
in this
74 year
22B
The bilateral paravertebral readily demonstrated on scan.
mass is this CT
Figure 22C Following therapy, there has been marked regression in size of the mass.
578
RadioGraphics
November
1982
Volume
2, Number
4
Zytak, CT
et at.
of the mediastinum
Osteophytes
1r:
Figure
23A
Paravertebral
widening
on the left in this radiograph 57 year
Figure
2, Number
4
November
1982
RadioGraphics
of a
old man.
23B
The CT scan demonstrates large osteophyte which counted for the widening.
Volume
is seen
the oc-
579
Zylak, CT
Retropharyngeal
et at.
of the
mediastinum
PATHOLOGY:
POSTERIOR
Hematoma
Figure
MEDIASTINAL
(POSTVASCULAR
Figure
24B
Figure
24C
COMPARTMENT
SPACE)
24A
This 57 year old man on anticoagulants developed dysphagia. The PA radiograph shows lateral displacement of the posteromedial aspect of each upper lung (arrowheads). The lateral mediastinal edge (arrow) represents the left subclavian artery.
Figures 24B, C & D The CT sequence shows extension of the retropharyngeal hematoma (h), situated posterior to the trachea and esophagus, down to the level of the azygos arch. The hematoma displaces the posteromedial aspect of each lung laterally. Note the hemothorax on the right. (Case courtesy of Dr. B. Raval, University Hospital, London, Ontario.)
580
RadioGraphics
November
1982
Volume
2, Number
4
Zytak, CT
et at.
of the mediastinum
Esophageal Duplication Cyst
I
Figure 25A A conventional
anteroposterior
tomogram
demonstrates a mass adjacent to the right side of the trachea extending inferiorly to the level of the right main bronchus.
Figure
25B
The CT scan is normal.
at the level of the azygos
Figure 25C On the CT scan 1 cm cephalad, with
a CT
cava.
Volume
2, Number
4
November
1982
RadioGraphics
the mass
number
near that of water is posterior to the superior vena
situated A developmental was proved by surgery. seen
arch
esophageal
cyst
581
Zylak, CT
et at.
of the
Lymphoma
mediastinum
PATHOLOGY:
POSTERIOR
MEDIASTINAL
(POSTVASCULAR
Figure
Figure
COMPARTMENT
SPACE)
26B
26A
This
posteroanterior radiograph masses (arr#{224}ws)in a 74 year lymphoma.
old
demonstrates patient with
I
Figure
Figures 26B, The sequence and carina.
582
C & D of CT scans
shows
the masses
to lie posterior
RadioGraphics
26C
to the heart
November
1982
[-
Volume
2, Number
:S
4
Zylak, CT
PATHOLOGY:
POSTERIOR
MEDIASTINAL
(POSTVASCULAR
of the
et at.
mediastinum
Hiatus
COMPARTMENT
Hernia
SPACE)
Figure The
27A posteroanterior
a 78 year
radiograph
old man
with
of
a fibroma
in the left lower lobe demonstrates widening of the inferior aspect
of
the mediastinum.
Figure
27B
This CT scan shows esophageal hiatus mediastinal
fat
a large hernia
accounting
parawith for
the
widening.
Volume
2, Number
4
November
1982
RadioGraphics
583
Zytak,
et at.
CT of the mediastinum
Sarcoidosis
Figure
PATHOLOGY:
MULTIPLE
COMPARTMENTS
28A
A posteroanterior radiograph man demonstrates enlargement fullness in the aortic-pulmonic
Widening
is also present
of a 30 year old of the lila, with window (arrow).
superiorly
on the right
( arrowheads).
Figure 28B On a CT scan and subcarinal strated.
Figure
3 cm below the carina, hilar adenopathy is demon-
28C
This CT scan demonstrates adenopathy lateral to the aortic arch (arrow) which accounts for loss of the aortic-pulmonic window. Note the enlarged pretracheal lymph
node
displacing
(small
arrow)
584
the
superior
vena
cava
laterally.
RadioGraphics
November
1982
Volume
2, Number
4
Zylak, CT
PATHOLOGY:
MULTIPLE
et at.
of the mediastinum
Oat
COMPARTMENTS
Cell
Carcinoma
Figures 29A & B Posteroanterior and lateral a mass
in the
Figure
29C
The
CT scan
lower
shows
enlargement
a mass of nodes into
radiographs
right
posterior
the azygoesophageal
lobe.
The
of a 51 year
old patient is not widened.
mediastinum
of the right
hilum
to the left atrium
and
extending
2, Number
Figure 29D This CT scan strates
anterior
recess.
Volume
demonstrate
4
November
1982
the
enlargement
at the level
presence
to the major
RadioGraphics
of the
right
of the azygos
of enlarged
nodes
hilum
arch posterior
and
demonand
vessels.
585
Zytak, CT
et at.
of the
Hodgkin’s
mediastinum
PATHOLOGY:
MULTIPLE
COMPARTMENTS
Disease
Figure 30A This posteroanterior radiograph of a 67 year old man demonstrates a soft tissue mass at the right cardiophrenic angle. There is widening of the mediastinum superiorly on the right (arrow).
586
RadioGraphics
November
1982
Volume
2, Number
4
Zylak, CT
of
et at.
the mediastinum
Hodgkin’s Disease
Figure The
3OB CT
scan
demonstrates
an enlarged
in the right cardiophrenic angle accounts for the mass demonstrated
lymph
node
(arrowhead) on the
that “plain
film.”
Figure This
3OC scan
demonstrates
in the azygoesophageal
Figure This
other
enlarged
recess
(arrow).
lymph
nodes
3OD CT
scan
shows
to the superior
vena
enlarged
cava,
lymph
and lateral
nodes
to
it
posterior (arrow) as
well.
Volume
2, Number
4
November
1982
RadioGraphics
587
Zylak, CT
et al.
of the
Hodgkin’s
mediastinum
PATHOLOGY:
MULTIPLE
COMPARTMENTS
Disease
Figure 3hA The posteroanterior radiograph of this 18 year old man demonstrates a large mass with effacement of the aorta and left heart border. The right side of the upper mediastinum is widened. The medial border of the left upper lobe is displaced laterally both anteriorly (arrow) and posteriorly (arrowheads). The trachea is displaced to the right.
Figure
The with
588
Figure
3hB
In this lateral the
major
radiograph,
airways
31C
CT scan shows a pericardial an adjacent mass.
effusion
RadioGraphics
(arrowheads)
November
1982
Volume
2, Number
4
posteriorly.
the mass displaces
Zytak, CT
PATHOLOGY:
MULTIPLE
of the
et at.
mediastinum
Hodgkin’s
COMPARTMENTS
Disease
V
I Figure
3hD
Marked compression of the main bronchi by the mass and areas of necrosis within it, are clearly shown on this CT scan.
..
,
5S
-k
1
.5 ,,,
.5
Figures 31E & F CT scans of the upper
mediastinum
demonstrate
of the mass posteriorly
(arrowhead)
and more
cannot
be clearly
defined
within
Volume
the tumor
2, Number
displacement
anteriorly
of the
medial
(arrow).
The trachea
1982
RadioGraphics
border
of the
is displaced
left
lung
to the right.
by extension
The
vessels
mass.
4
November
589
Zylak, CT
et at.
of the mediastinum
Hodgkin’s
PATHOLOGY:
MULTIPLE
COMPARTMENTS
Disease
5
-0
4
-
6-i-
5
Figure
3
32A
Figure 32A The posteroanterior radiograph left. Bilateral hilar adenopathy are displaced to the left (1). The this is the interface between the by the subclavian artery (4). On anterior margin; 6, the posterior Figure 32B This anteroposterior conventional and subcarinal lymph nodes.
590
Figure
32B
of a 15 year old girl showing a large mediastinal mass displacing the trachea to the and a subcarinal mass are evident. The aortic arch and proximal descending aorta edge medial to the aortic knob (2) represents lung adjacent to the mass. Medial to lung and the mass more anteriorly (3). Superiorly on the left is the edge produced the right, the mass involves the entire thickness of the mediastinum, 5 represents the margin (cf. Figures 32E & F).
tomogram
RadioGraphics
shows
the posterosuperior
November
1982
extent
of the mass
and
Volume
2, Number
4
enlargement
of hilar
Zylak, CT
PATHOLOGY:
MULTIPLE
of the
et at.
mediastinum
Hodgkin’s
COMPARTMENTS
Disease
Figure
32C
Figure
This CT scan demonstrates node enlargement. Note scending aorta.
subcarinal and the compression
hilar lymph of the de-
Figures 32E & F CT scans through the upper mediastinum the mediastinal edges described in Figure
Volume
2, Number
4
show 32A.
November
32D
This CT scan demonstrates marked compression and elevation of the right pulmonary artery by the mass. Enlarged hilar lymph nodes on the left are also shown.
tracheal
compression
1982
by the mass.
RadioGraphics
Numbers
correspond
to
591
Zylak, CT
et al.
of the
Summary
mediastinum
This images
presentation of
the
anatomy. it
has
Having been
entire
length
of the
and
the
Various
ment
References
B. RG,
compartments
have
been
singularly
1977,
as comprising
anterior
used
The efforts
of Mrs. Deborah
University,
3
through mediastinal
the com-
compartment
(vascular
(postvascular
space).
to demonstrate
involve-
or in combination.
W. B. Saunders,
p. 137.
ER. The mediastinum. C. Marchand P. The anatomy and applied 6:359-368.
RadioGraphics
the
mediastinal
CT
sectional entities,
uninterruptedly
compartment
entities
Heitzman
at McMaster knowledged.
592
mediastinal
pathological
mediastinum
are
middle
with
cross
The mediastinum. Semin Roentgenol 1969; 4:41-58. Pare JAP. Diagnosis of Diseases of the Chest. 2nd edition,
Philadelphia, 4.
posterior
of the
and
continuing These
the
and
morphology
mediastinum. space),
radiographs
conventional
to think
each
pathological
of these
1. Felson 2. Fraser 3.
normal
convenient
(prevascular
conventional
utilizing
compartments
partment space),
correlated
considered
found
longitudinal
has
mediastinum,
Mosby,
St. Louis,
anatomy
1977, of the mediastinal
Miller for the excellent
and Monika
November
V.
Ferrier
1982
artwork,
for typing
Volume
p.
the Audiovisual
the manuscript,
2, Number
2-4. fascia.
4
Thorax
1951;
Department
are gratefully
ac-
