anatomy of mediastinum

Question 1

where does superior mediastinum and inferior mediastinum divided?

Accepted Answer

(at transverse plane view) extends from sternal angle to the IV disc bertween T4 & T5 vertebrae

Question 2

What is Superior vena cava syndrome (SVC) ?

Accepted Answer

Obstruction (blockage) of SVC

Question 3

Why does SVC blockage can cause syndrome?

Accepted Answer

Because the SVC drains blood from above the diaphragm (head, neck, face, arms) When blocked → pressure builds up upstream.

Question 4

SVC obstruction : Engorgement of veins (big, visible veins)

Accepted Answer

Blood can’t drain → pressure builds → 👉 Neck veins (JVD) and chest veins become swollen 👉 Body creates collateral veins to bypass the blockage

Question 5

SVC obstruction : Facial swelling / facial plethora

Accepted Answer

Blood pools in the face → 👉 Face looks puffy, red, bluish, worse when lying down

Question 6

SVC obstruction : Dyspnea (shortness of breath)

Accepted Answer

Why breathing becomes hard:
• Swollen veins compress the airway
• Mediastinal mass may directly press on the trachea
• Venous congestion causes airway edema

👉 That’s why patients may have stridor or cough too

Question 7

SVC obstruction : Dysphagia (difficulty swallowing)

Accepted Answer

The esophagus runs through the mediastinum Compression or congestion → swallowing feels difficult

Question 8

SVC obstruction : Hoarseness of voice

Accepted Answer

The recurrent laryngeal nerve runs in the mediastinum Compression → hoarse voice

Question 9

SVC obstruction : Cerebral edema (dangerous part)

Accepted Answer

Blood from the brain can’t drain properly → 👉 Increased intracranial pressure 👉 Headache, confusion, drowsiness 👉 In severe cases: loss of consciousness

Question 10

Pemberton's maneuver test

Accepted Answer

What the test does:
• Patient raises both arms for ~1 minute

What happens physiologically:
• This further narrows venous drainage at the thoracic inlet
• If SVC is already partially blocked → congestion worsens

Positive test =
• Facial flushing
• Bluish discoloration
• Difficulty breathing

👉 This strongly suggests SVC obstruction

Question 11

Mediastinitis

Accepted Answer

Mediastinitis is inflammation/infection of the mediastinum, usually spreading from nearby structures.

Causes (HIGH-YIELD)
• Deep neck infections
→ spread downward into mediastinum via loose connective tissue
• Esophageal injury
• Penetrating chest wound
• Esophageal perforation
• Air leakage from esophagus
→ air tracks up → subcutaneous emphysema

Key anatomical reason (exam favourite)
• Pretracheal space
• Lies anterior to trachea
• Infection spreads → mediastinitis
• Fascia continuous with:
• Pericardium → pericardial effusion
• Parietal pleura → empyema

👉 Buzzwords to drop: pretracheal space, loose fascia, empyema, pericardial effusion

Question 12

medistinal tumors/ cyst

Accepted Answer

Important pressure effects
• Left lung tumour
→ mediastinal lymph nodes enlarge
→ compress left recurrent laryngeal nerve
→ hoarseness of voice
• Tumour / cyst compressing SVC
→ SVC syndrome
→ facial swelling, dilated upper limb veins
• Other structures compressed:
• Sympathetic trunk
• Phrenic nerve
• Trachea
• Main bronchi
• Esophagus

Question 13

anterior mediastinal mass

Accepted Answer

Think “4 Ts”
• Thymus
• Thymoma
• Thymic cyst
• Enlarged thymus
• Tumour
• Germ cell tumour
• Teratoma
• Tissue (Lymphoid)
• Lymphoma
• Leukemia
• TB

📌 If exam says anterior mediastinum → lymphoma / thymus / germ cell

Question 14

middle mediastinal mass

Accepted Answer

Think airways + nodes • Foregut duplication cysts • Bronchogenic cyst • Lymphadenopathy • Tuberculosis • Fungal infection • Vascular malformation 📌 Middle = cysts + lymph nodes

Question 15

posterior mediastinal mass

Accepted Answer

Think nerves & spine • Neurogenic tumours • Thoracic neuroblastoma • Neurofibroma • Extra-medullary hematopoiesis • Vascular malformation 📌 Posterior = neurogenic

anatomy of mediastinum

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