Anterior and posterior mediastinum. Boundaries of the posterior mediastinum

Mediastinal tumor is a relatively rare pathology. According to statistics, formations in this area occur in no more than 6-7% of all human tumors. Most of them are benign, only a fifth are initially malignant.

Among patients with mediastinal tumors, there are approximately the same number of men and women, and the predominant age of patients is 20-40 years, that is, the most active and young part of the population suffers.

From a morphological point of view, tumors of the mediastinal region are extremely heterogeneous, but almost all of them, even benign in nature, are potentially dangerous due to possible compression of surrounding organs. In addition, the peculiarity of their localization makes them difficult to remove, which is why they seem to be one of the most difficult problems in thoracic surgery.

Most people who are far from medicine have a very vague idea of what the mediastinum is and what organs are located there. In addition to the heart, the structures of the respiratory system, large vascular trunks and nerves, and the lymphatic apparatus of the chest, which can give rise to all sorts of formations, are concentrated in this area.

The mediastinum (mediastinum) is a space, the anterior part of which is formed by the sternum, the anterior sections of the ribs, covered from the inside by the retrosternal fascia. The posterior mediastinal wall is the anterior surface of the spinal column, the prevertebral fascia and the posterior segments of the ribs. The lateral walls are represented by layers of the pleura, and from below the mediastinal space is closed by the diaphragm. The upper part does not have a clear anatomical boundary; it is an imaginary plane running through the upper end of the sternum.

Within the mediastinum are the thymus, the upper segment of the superior vena cava, the aortic arch and arterial vascular lines originating from it, the thoracic lymphatic duct, nerve fibers, fiber, the esophagus passes behind, the heart in the pericardial sac is located in the middle zone, the zone of division of the trachea into bronchi, pulmonary vessels.

The mediastinum is divided into upper, middle and lower floors, as well as anterior, middle and posterior parts. To analyze the extent of tumor spread, the mediastinum is conventionally divided into upper and lower halves, the border between which is the upper part of the pericardium.

The posterior mediastinum is characterized by the growth of neoplasia from lymphoid tissue (), neurogenic tumors, and metastatic cancers of other organs. In the anterior mediastinal region, lymphoma and teratoid tumors, mesenchymomas from connective tissue components are formed, and the risk of malignancy of neoplasia of the anterior mediastinum is higher than in other parts. In the middle mediastinum, lymphomas, cystic cavities of bronchogenic and dysembryogenetic origin, and other cancers are formed.

Tumors of the upper mediastinum are thymomas, lymphomas and intrathoracic goiter, as well as. In the middle floor, thymomas and bronchogenic cysts are found, and in the lower mediastinal region, pericardial cysts and fatty tumors are found.

Classification of mediastinal neoplasia

The tissues of the mediastinum are extremely diverse, so tumors in this area are united only by a common location, otherwise they are diverse and have different sources of development.

Tumors of the mediastinal organs can be primary, that is, initially growing from the tissues of this area of the body, as well as secondary - metastatic nodes of cancer of another localization.

Primary mediastinal neoplasias are distinguished by histogenesis, that is, the tissue that became the ancestor of the pathology:

Neurogenic - ganglioneuroma - grow from peripheral nerves and nerve ganglia;
Mesenchymal - fibroma, etc.;
Lymphoproliferative - Hodgkin's disease, lymphoma, lymphosarcoma;
Dysontogenetic (formed due to a violation of embryonic development) - teratomas, chorionepithelioma;
- neoplasia of the thymus gland.

Mediastinal neoplasms are mature and immature, while mediastinal cancer is not an entirely correct formulation, given the sources of its origin. Epithelial neoplasia is called cancer, and connective tissue formations and teratomas are found in the mediastinum. Cancer in the mediastinum is possible, but it will be secondary, that is, it will arise as a result of metastasis of carcinoma of another organ.

Thymomas- These are tumors of the thymus gland that affect people 30-40 years old. They make up approximately one fifth of all mediastinal tumors. There are malignant thymoma with a high degree of invasion (sprouting) of surrounding structures, and benign. Both varieties are diagnosed with approximately equal frequency.

Dysembryonic neoplasia- also not uncommon in the mediastinum; up to a third of all teratomas are malignant. They are formed from embryonic cells that have remained here since intrauterine development, and contain components of epidermal and connective tissue origin. Usually the pathology is detected in adolescents. Immature teratomas grow actively and metastasize to the lungs and nearby lymph nodes.

Favorite location of tumors neurogenic origin- nerves of the posterior mediastinum. Carriers can be the vagus and intercostal nerves, spinal membranes, and sympathetic plexus. They usually grow without causing any concern, but the spread of neoplasia into the spinal cord canal can cause compression of the nervous tissue and neurological symptoms.

Tumors of mesenchymal origin- the widest group of neoplasms, diverse in structure and source. They can develop in all parts of the mediastinum, but more often in the anterior part. Lipomas are benign tumors of adipose tissue, usually unilateral, can spread up or down the mediastinum, penetrating from the anterior to the posterior part.

Lipomas They have a soft consistency, which is why symptoms of compression of adjacent tissues do not occur, and pathology is discovered by chance during examination of the chest organs. Its malignant counterpart, liposarcoma, is extremely rarely diagnosed in the mediastinum.

Fibroids are formed from fibrous connective tissue, grow asymptomatically for a long time, and call the clinic when they reach large sizes. They can be multiple, of different shapes and sizes, and have a connective tissue capsule. Malignant fibrosarcoma grows quickly and provokes the formation of effusion in the pleural cavity.

Hemangiomas- tumors from blood vessels are quite rare in the mediastinum, but usually affect its anterior section. Neoplasms from lymphatic vessels - lymphangiomas, hygromas - are usually found in children, form nodes, and can grow into the neck, causing displacement of other organs. Uncomplicated forms are asymptomatic.

Mediastinal cyst- This is a tumor-like process, which is a rounded cavity. Cysts can be congenital or acquired. Congenital cysts are considered a consequence of a disorder of embryonic development, and their source can be tissue of the bronchus, intestines, pericardium, etc. - bronchogenic, enterogenic cystic formations, teratomas. Secondary cysts are formed from the lymphatic system and tissues that are normally present here.

Symptoms of mediastinal tumors

For a long time, a mediastinal tumor can grow hidden, and signs of the disease appear later, when compression of the surrounding tissues occurs, they grow, and metastasis begins. In such cases, pathology is detected during examination of the chest organs for other reasons.

The location, volume and degree of differentiation of the tumor determine the duration of the asymptomatic period. Malignant tumors grow faster, so the clinic appears earlier.

The main signs of mediastinal tumors include:

Symptoms of compression or invasion of neoplasia into surrounding structures;
General changes;
Specific changes.

The main manifestation of the pathology is pain, which is associated with the pressure of the neoplasm or its invasion of nerve fibers. This sign is characteristic not only of immature, but also of completely benign tumor processes. The pain is on the side of the growth pathology, not too intense, nagging, can radiate to the shoulder, neck, interscapular area. With left-sided pain, it can be very similar to that of angina pectoris.

An increase in pain in the bones is considered an unfavorable symptom, which most likely indicates possible metastasis. For the same reason, pathological fractures are possible.

Characteristic symptoms appear when nerve fibers are involved in tumor growth:

Drooping of the eyelid (ptosis), recessed eye and dilated pupil due to neoplasia, sweating disorder, fluctuations in skin temperature indicate involvement of the sympathetic plexus;
Hoarseness of voice (the laryngeal nerve is affected);
Increased level of the diaphragm during germination of the phrenic nerves;
Sensitivity disorders, paresis and paralysis due to compression of the spinal cord and its roots.

One of the symptoms of compression syndrome is the narrowing of the venous lines by a tumor, more often the superior vena cava, which is accompanied by difficulty in venous outflow from the tissues of the upper body and head. Patients in this case complain of noise and a feeling of heaviness in the head, increasing when bending, pain in the chest, shortness of breath, swelling and cyanosis of the facial skin, dilation and overflow of blood in the neck veins.

The pressure of the neoplasm on the respiratory tract provokes coughing and difficulty breathing, and compression of the esophagus is accompanied by dysphagia, when it is difficult for the patient to eat.

General signs of tumor growth are weakness, decreased performance, fever, sweating, weight loss, which indicate the malignancy of the pathology. The progressive enlargement of the tumor causes intoxication with the products of its metabolism, which is associated with joint pain, edema, tachycardia, and arrhythmias.

Specific symptoms characteristic of certain types of mediastinal neoplasms. For example, lymphosarcoma causes itchy skin and sweating, while fibrosarcoma occurs with episodes of hypoglycemia. Intrathoracic goiter with elevated hormone levels is accompanied by signs of thyrotoxicosis.

Symptoms of a mediastinal cyst is associated with the pressure it exerts on neighboring organs, so the manifestations will depend on the size of the cavity. In most cases, cysts are asymptomatic and do not cause any discomfort to the patient.

When a large cystic cavity puts pressure on the mediastinal contents, shortness of breath, coughing, difficulty swallowing, a feeling of heaviness and chest pain may occur.

Dermoid cysts, which are a consequence of intrauterine development disorders, often give symptoms of cardiac and vascular disorders: shortness of breath, cough, heart pain, increased heart rate. When the cyst is opened into the lumen of the bronchus, a cough appears with the release of sputum, in which hair and fat are visible.

Dangerous complications of cysts are their ruptures with an increase in pneumothorax, hydrothorax, and the formation of fistulas in the chest cavities. Bronchogenic cysts can suppurate and lead to hemoptysis when opened into the lumen of the bronchus.

Thoracic surgeons and pulmonologists often encounter neoplasms in the mediastinal region. Given the variety of symptoms, diagnosing mediastinal pathology presents significant difficulties. To confirm the diagnosis, radiography, MRI, CT, as well as endoscopic procedures (bronchoscopy and mediastinoscopy) are used. A biopsy can definitively verify the diagnosis.

Video: lecture on the diagnosis of tumors and mediastinal cysts

Treatment

Surgery is recognized as the only correct method of treatment for mediastinal tumors. The sooner it is performed, the better the prognosis for the patient. For benign formations, open intervention is performed with complete excision of the focus of neoplasia growth. In case of malignancy of the process, the most radical removal is indicated, and depending on the sensitivity to other types of antitumor treatment, chemotherapy and radiation therapy are prescribed, both independently and in combination with surgery.

When planning a surgical procedure, it is extremely important to choose the right approach that will give the surgeon the best view and space for manipulation. The likelihood of relapse or progression of the pathology depends on the radicality of the removal.

Radical removal of tumors in the mediastinal area is performed by thoracoscopy or thoracotomy - anterolateral or lateral. If the pathology is located retrosternally or on both sides of the chest, longitudinal sternotomy with incision of the sternum is considered preferable.

Videothoracoscopy- a relatively new method of treating a mediastinal tumor, in which the intervention is accompanied by minimal surgical trauma, but, at the same time, the surgeon has the opportunity to examine the affected area in detail and remove the altered tissue. Videothoracoscopy allows achieving high treatment results even in patients with serious underlying pathology and a small functional reserve for further recovery.

In case of severe concomitant diseases that complicate surgery and anesthesia, palliative treatment is carried out in the form of tumor removal using transthoracic ultrasound or partial excision of tumor tissue to decompress mediastinal formations.

Video: lecture on surgery for mediastinal tumors

Forecast for mediastinal tumors is ambiguous and depends on the type and degree of differentiation of the tumor. For thymomas, cysts, retrosternal goiter, mature connective tissue neoplasia, it is favorable provided they are removed in a timely manner. Malignant tumors not only compress and grow into organs, disrupting their function, but also actively metastasize, which leads to an increase in cancer intoxication, the development of serious complications and the death of the patient.

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

The mediastinum is an anatomical space, the middle region of the chest. The mediastinum is limited in front by the sternum, and in the back by the spine. On the sides of this organ there are pleural cavities.

For various purposes (surgery, planning radiation therapy, describing the localization of pathology), the mediastinum, in accordance with the scheme proposed by Twining in 1938, is divided into upper and lower, as well as anterior, posterior and middle sections.

Anterior, middle, posterior mediastinum

The anterior mediastinum is limited in front by the sternum, in the back by the brachiocephalic veins, pericardium and brachiocephalic trunk. In this space there are the internal mammary veins, the thoracic artery, the mediastinal lymph nodes and the thymus gland.

Structure of the middle mediastinum: heart, vena cava, brachiocephalic veins and brachiocephalic trunk, aortic arch, ascending aorta, phrenic veins, main bronchi, trachea, pulmonary veins and arteries.

The posterior mediastinum is limited by the trachea and pericardium in the anterior part, and in the posterior part by the spine. This part of the organ contains the esophagus, descending aorta, thoracic lymphatic duct, semi-gyzygos and azygos veins, as well as the posterior lymph nodes of the mediastinum.

Superior and inferior mediastinum

The superior mediastinum includes all the anatomical structures that lie above the upper edge of the pericardium: its boundaries are the superior sternal aperture and the line drawn between the angle of the chest and the intervertebral disc Th4-Th5.

The inferior mediastinum is limited by the superior edges of the diaphragm and pericardium and, in turn, is also divided into anterior, middle and posterior parts.

Classification of mediastinal tumors

Neoplasms of the organ are considered not only true tumors of the mediastinum, but also tumor-like diseases and cysts that differ in etiology, localization and course of the disease. Each of the mediastinal neoplasms originates from tissues of different origins, united only by anatomical boundaries. They are divided into:

Mediastinal tumors are detected mainly in young and middle age with equal frequency in both men and women. Despite the fact that mediastinal diseases may not manifest themselves for a long time and are detected only during a preventive study, there are several symptoms that characterize disorders of this anatomical space:

Mild pain localized at the site of the tumor and radiating to the neck, shoulder, and interscapular area;
Dilation of the pupil, drooping of the eyelid, retraction of the eyeball - can occur if the tumor grows in the borderline sympathetic trunk;
Hoarseness of voice – originates from damage to the recurrent laryngeal nerve;
Heaviness, noise in the head, shortness of breath, chest pain, cyanosis and swelling of the face, swelling of the veins of the chest and neck;
Impaired passage of food through the esophagus.

In the later stages of mediastinal diseases, increased body temperature, general weakness, arthralgic syndrome, cardiac arrhythmia, and swelling of the extremities are observed.

Mediastinal lymphadenopathy

Lymphadenopathy or enlargement of the lymph nodes of a given organ is observed with metastases of carcinoma, lymphomas, as well as some non-tumor diseases (sarcoidosis, tuberculosis, etc.).

The main symptom of the disease is generalized or localized enlargement of the lymph nodes, however, mediastinal lymphadenopathy may have additional manifestations such as:

Increased body temperature, sweating;
Loss of body weight;
Frequent infection of the upper respiratory tract (tonsillitis, pharyngitis, tonsillitis);
Hepatomegaly and splenomegaly.

Damage to the lymph nodes, characteristic of lymphomas, can be isolated or combined with the germination of tumors into other anatomical structures (trachea, blood vessels, bronchi, pleura, esophagus, lungs).

21.02.2017

The mediastinum, mediastinum, is part of the chest cavity, delimited above by the superior thoracic opening, below by the diaphragm, in front by the sternum, behind by the spinal column, and on the sides by the mediastinal pleura.

Mediastinum, mediastinum - part of the chest cavity, delimited at the top by the superior thoracic opening, below - by the diaphragm, in front - by the sternum, behind - by the spinal column, on the sides - by the mediastinal pleura. The mediastinum contains vital organs and neurovascular bundles. The organs of the mediastinum are surrounded by loose fatty tissue, which communicates with the tissue of the neck and retroperitoneal space, and through the tissue of the roots with the interstitial tissue of the lungs. The mediastinum separates the right and left pleural cavities. Topographically, the mediastinum is a single space, but for practical purposes it is divided into two sections: the anterior and posterior mediastinum, mediastinum anterius et posterius.

The boundary between them corresponds to a plane close to the frontal one and passes at the level of the posterior surface of the trachea and the roots of the lungs (Fig. 229).

Rice. 229. Topographic relationships in the mediastinum (left view according to V. N. Shevkunenko)

1 - esophagus; 2 - vagus nerve; 3 - thoracic lymphatic duct; 4 - aortic arch; 5 - left recurrent nerve; 6 - left pulmonary artery; 7 - left bronchus; 8 - hemizygos vein; 9 - sympathetic trunk; 10 - diaphragm; 11 - pericardium; 12 - thoracic aorta; 13 - pulmonary veins; 14 - pericardial-phrenic arteries and vein; 15 - Wriesberg knot; 16 - pleura; 17 - phrenic nerve; 18 - left common carotid artery; 19 - left subclavian artery.

The anterior mediastinum contains: the heart and pericardium, the ascending aorta and its arch networks, the pulmonary trunk and its branches, the superior vena cava and brachiocephalic veins; bronchial arteries and veins, pulmonary veins; trachea and bronchi; the thoracic part of the vagus nerves, lying above the level of the roots; phrenic nerves, lymph nodes; in children, the spinal gland is located in the spinal gland, and in adults, it is the adipose tissue that replaces it.

In the posterior mediastinum are located: the esophagus, descending aorta, inferior vena cava, azygos and semi-gyzygos veins, thoracic lymphatic duct and lymph nodes; the thoracic part of the vagus nerves, lying below the roots of the lungs; borderline sympathetic trunk along with splanchnic nerves, nerve plexuses.

The lymph nodes of the anterior and posterior mediastinum anastomose with each other and with the lymph nodes of the neck and retroperitoneal space.

Taking into account the peculiarities of the location of individual anatomical formations and pathological processes, in particular the lymph nodes, in practical work it is accepted to divide the anterior mediastinum into two sections: the anterior one, the retrosternal space itself, and the posterior one, called the middle mediastinum, in which the trachea and the surrounding lymph nodes are located. The border between the anterior and middle mediastinum is the frontal plane drawn along the anterior wall of the trachea. In addition, a conditionally drawn horizontal plane passing at the level of the bifurcation of the trachea, the mediastinum is divided into upper and lower.

The lymph nodes. According to the International Anatomical Nomenclature, the following groups of lymph nodes are distinguished: tracheal, upper and lower tracheobronchial, bronchopulmonary, pulmonary, anterior and posterior mediastinal, parasternal, intercostal and diaphragmatic. However, for practical purposes, taking into account the different localization of individual groups of lymph nodes in the corresponding parts of the mediastinum and the characteristics of regional lymph drainage, we consider it advisable to use the classification of intrathoracic lymph nodes proposed by Rouviere and supplemented by D. A. Zhdanov.

According to this classification, parietal (parietal) and splanchnic (visceral) lymph nodes are distinguished. The parietal ones are located on the inner surface of the chest wall between the internal pectoral fascia and the parietal pleura, the visceral ones are densely adjacent to the mediastinal organs. Each of these groups in turn consists of separate subgroups of nodes, the name and location of which are presented below.

Parietal lymph nodes. 1. Anterior, parasternal, lymph nodes (4-5) are located on both sides of the sternum, along the internal thoracic blood vessels. They receive lymph from the mammary glands and the anterior chest wall.

Posterior, paravertebral, lymph nodes are located under the parietal pleura along the lateral and anterior surface of the vertebrae, below the level of the VI thoracic vertebra.

Intercostal lymph nodes are located along the grooves of the II - X ribs, each of them contains from one to six nodes.

The posterior intercostal nodes are constant, the lateral ones are less constant.

The peri-sternal, parasternal and intercostal lymph nodes receive lymph from the chest wall and anastomose with the lymph nodes of the neck and retroperitoneum.

Internal lymph nodes. In the anterior mediastinum there are several groups of lymph nodes.

The superior prevascular lymph nodes are located in three chains:

a) prevenous - along the superior vena cava and the right brachiocephalic vein (2-5 nodes);

b) pre-aortocarotid (3-5 nodes) begin with the node of the ligament arteriosus, cross the aortic arch and continue to the top, the lobar carotid artery;

c) the transverse chain (1-2 nodes) is located along the left brachiocephalic vein.

Preacular lymph nodes receive lymph from the neck, partly from the lungs, and the thymus gland
and hearts.

Lower diaphragmatic - consist of two groups of nodes:

a) prepericardial (2-3 nodes) are located behind the body of the sternum and the xiphoid process at the site of attachment of the diaphragm to the seventh costal cartilage;

b) lateropericardial (1-3 nodes) on each side are grouped above the diaphragm, along the lateral surfaces of the pericardium; the right nodes are more permanent and are located next to the inferior vena cava.

The lower diaphragmatic nodes receive lymph from the anterior parts of the diaphragm and partially from the liver.

The following groups of lymph nodes are located in the middle mediastinum.

Peritracheal lymph nodes (right and left) lie along the right and left walls of the trachea, non-permanent (posterior) - posterior to it. The right chain of peritracheal lymph nodes is located behind the superior vena cava and brachiocephalic veins (3-6 nodes). The lowest node of this chain is located directly above the junction of the azygos vein with the superior vena cava and is called the node of the azygos vein. On the left, the peritracheal group consists of 4-5 small nodes and is close to the left one in the recurrent nerve. The lymph nodes of the left and right peritracheal chain are anastomosed.

Tracheo - bronchial (1-2 nodes) are located in the outer corners formed by the trachea and main bronchi. The right and left tracheobronchial lymph nodes are mainly adjacent to the anterolateral surfaces of the trachea and main bronchi.

Bifurcation nodes (3-5 nodes) are located in the interval between the bifurcation of the trachea and the pulmonary veins, mainly along the lower wall of the right main bronchus.

Broncho - pulmonary lies in the region of the roots of the lungs, in the angles of division of the main, lobar and segmental bronchos. In relation to the lobar bronchi, the upper, lower, anterior and posterior bronchopulmonary nodes are distinguished.

The nodes of the pulmonary ligaments are unstable, located between the layers of the pulmonary ligament.

Intrapulmonary nodes are located along the segmental bronchi, arteries, at the angles of their branching into subsegmental branches.

The lymph nodes of the middle mediastinum receive lymph from the lungs, trachea, larynx, pharynx, esophagus, thyroid gland, and heart.

In the posterior mediastinum there are two groups of lymph nodes.

1.0 coloesophageal (node 2-5) located along the lower esophagus.

2. Interoesophageal (1-2 nodes) along the descending aorta at the level of the lower pulmonary veins.

The lymph nodes of the posterior mediastinum receive lymph from the food and partly from the abdominal organs.

Lymph from the lungs and mediastinum is collected by efferent vessels, which fall into the thoracic lymphatic duct (ductus thoracicus), which flows into the left brachiocephalic vein.

Normally, the lymph nodes are small (0.3-1.5 cm). Bifurcation lymph nodes reach 1.5-2 cm.

Tags: mediastinum
Start of activity (date): 02/21/2017 11:14:00
Created by (ID): 645
Key words: mediastinum, pleura, interstitial tissue

Mediastinal surgery, one of the youngest branches of surgery, has received significant development due to the development of issues of anesthesia, surgical techniques, diagnosis of various mediastinal processes and neoplasms. New diagnostic methods make it possible not only to accurately establish the localization of a pathological formation, but also make it possible to assess the structure and structure of the pathological focus, as well as obtain material for pathomorphological diagnosis. Recent years have been characterized by the expansion of indications for surgical treatment of mediastinal diseases, the development of new highly effective, low-traumatic treatment methods, the introduction of which has improved the results of surgical interventions.

Classification of mediastinal disease.

Mediastinal injuries:

1. Closed trauma and wounds of the mediastinum.

2. Damage to the thoracic lymphatic duct.

Specific and nonspecific inflammatory processes in the mediastinum:

1. Tuberculous adenitis of the mediastinum.

2. Nonspecific mediastinitis:

A) anterior mediastinitis;

B) posterior mediastinitis.

According to the clinical course:

A) acute non-purulent mediastinitis;

B) acute purulent mediastinitis;

B) chronic mediastinitis.

Mediastinal cysts.

1. Congenital:

A) coelomic pericardial cysts;

B) cystic lymphangitis;

B) bronchogenic cysts;

D) teratomas

D) from the embryonic embryo of the foregut.

2. Purchased:

A) cysts after hematoma in the pericardium;

B) cysts formed as a result of the disintegration of a pericardial tumor;

D) mediastinal cysts arising from the border areas.

Mediastinal tumors:

1. Tumors arising from the organs of the mediastinum (esophagus, trachea, large bronchi, heart, thymus, etc.);

2. Tumors arising from the walls of the mediastinum (tumors of the chest wall, diaphragm, pleura);

3. Tumors arising from the tissues of the mediastinum and located between organs (extraorgan tumors). Tumors of the third group are true tumors of the mediastinum. They are divided according to histogenesis into tumors of nervous tissue, connective tissue, blood vessels, smooth muscle tissue, lymphoid tissue and mesenchyme.

A. Neurogenic tumors (15% of this location).

I. Tumors arising from nervous tissue:

A) sympathoneuroma;

B) ganglioneuroma;

B) pheochromocytoma;

D) chemodectoma.

II. Tumors arising from nerve sheaths.

A) neuroma;

B) neurofibroma;

B) neurogenic sarcoma.

D) schwannomas.

D) ganglioneuromas

E) neurilemmomas

B. Connective tissue tumors:

A) fibroma;

B) chondroma;

B) osteochondroma of the mediastinum;

D) lipoma and liposarcoma;

D) tumors arising from blood vessels (benign and malignant);

E) myxomas;

G) hibernomas;

E) tumors from muscle tissue.

B. Tumors of the thymus gland:

A) thymoma;

B) thymus cysts.

D. Tumors from reticular tissue:

A) lymphogranulomatosis;

B) lymphosarcoma and reticulosarcoma.

E. Tumors from ectopic tissues.

A) retrosternal goiter;

B) intrathoracic goiter;

B) adenoma of the parathyroid gland.

The mediastinum is a complex anatomical formation located in the middle of the thoracic cavity, enclosed between the parietal layers, spinal column, sternum and lower diaphragm, containing fiber and organs. The anatomical relationships of the organs in the mediastinum are quite complex, but knowledge of them is mandatory and necessary from the standpoint of the requirements for providing surgical care to this group of patients.

The mediastinum is divided into anterior and posterior. The conventional boundary between them is the frontal plane drawn through the roots of the lungs. In the anterior mediastinum there are: the thymus gland, part of the aortic arch with branches, the superior vena cava with its sources (brachiocephalic veins), the heart and pericardium, the thoracic part of the vagus nerves, the phrenic nerves, the trachea and the initial sections of the bronchi, nerve plexuses, lymph nodes. In the posterior mediastinum there are: the descending aorta, azygos and semi-gypsy veins, the esophagus, the thoracic part of the vagus nerves below the roots of the lungs, the thoracic lymphatic duct (thoracic region), the border sympathetic trunk with the splanchnic nerves, nerve plexuses, lymph nodes.

To establish a diagnosis of the disease, localization of the process, its relationship to neighboring organs, in patients with mediastinal pathology, it is first necessary to conduct a full clinical examination. It should be noted that the disease in the initial stages is asymptomatic, and pathological formations are an accidental finding during fluoroscopy or fluorography.

The clinical picture depends on the location, size and morphology of the pathological process. Typically, patients complain of pain in the chest or heart area, interscapular area. Painful sensations are often preceded by a feeling of discomfort, expressed in a feeling of heaviness or foreign formation in the chest. Shortness of breath and difficulty breathing are often observed. When the superior vena cava is compressed, cyanosis of the skin of the face and upper half of the body and their swelling may be observed.

When examining the mediastinal organs, it is necessary to conduct thorough percussion and auscultation and determine the function of external respiration. Important during the examination are electro- and phonocardiographic studies, ECG data, and X-ray studies. Radiography and fluoroscopy are carried out in two projections (direct and lateral). When a pathological focus is identified, tomography is performed. The study, if necessary, is supplemented with pneumomediastinography. If the presence of a substernal goiter or an aberrant thyroid gland is suspected, ultrasound examination and scintigraphy with I-131 and Tc-99 are performed.

In recent years, when examining patients, instrumental research methods have been widely used: thoracoscopy and mediastinoscopy with biopsy. They allow a visual assessment of the mediastinal pleura, partly the mediastinal organs, and collection of material for morphological examination.

Currently, the main methods for diagnosing mediastinal diseases, along with radiography, are computed tomography and nuclear magnetic resonance.

Features of the course of individual diseases of the mediastinal organs:

Damage to the mediastinum.

Frequency - 0.5% of all penetrating chest wounds. Damage is divided into open and closed. Features of the clinical course are caused by bleeding with the formation of a hematoma and compression of organs, vessels and nerves.

Signs of mediastinal hematoma: slight shortness of breath, mild cyanosis, swelling of the neck veins. X-ray shows darkening of the mediastinum in the area of the hematoma. Often a hematoma develops against the background of subcutaneous emphysema.

When the vagus nerves are imbibited by blood, vagal syndrome develops: respiratory failure, bradycardia, deterioration of blood circulation, and confluent pneumonia.

Treatment: adequate pain relief, maintaining cardiac activity, antibacterial and symptomatic therapy. With progressive mediastinal emphysema, puncture of the pleura and subcutaneous tissue of the chest and neck with short and thick needles to remove air is indicated.

When the mediastinum is injured, the clinical picture is complemented by the development of hemothorax and hemothorax.

Active surgical tactics are indicated for progressive impairment of external respiratory function and ongoing bleeding.

Damage to the thoracic lymphatic duct can occur with:

1. closed chest injury;
2. knife and gunshot wounds;
3. during intrathoracic operations.

As a rule, they are accompanied by a severe and dangerous complication: chylothorax. If conservative therapy is unsuccessful, surgical treatment is required within 10-25 days: ligation of the thoracic lymphatic duct above and below the injury, in rare cases, parietal suturing of the duct wound, implantation into the azygos vein.

Inflammatory diseases.

Acute nonspecific mediastinitis- inflammation of the mediastinal tissue caused by a purulent nonspecific infection.

Acute mediastinitis can be caused by the following reasons.

Open mediastinal injuries.
1. Complications of operations on the mediastinal organs.
2. Contact spread of infection from adjacent organs and cavities.
3. Metastatic spread of infection (hematogenous, lymphogenous).
4. Perforation of the trachea and bronchi.
5. Perforation of the esophagus (traumatic and spontaneous rupture, instrumental damage, damage by foreign bodies, tumor disintegration).

The clinical picture of acute mediastinitis consists of three main symptom complexes, the varying severity of which leads to a variety of its clinical manifestations. The first symptom complex reflects the manifestations of severe acute purulent infection. The second is associated with the local manifestation of a purulent focus. The third symptom complex is characterized by the clinical picture of damage or disease that preceded the development of mediastinitis or was its cause.

General manifestations of mediastinitis: fever, tachycardia (pulse - up to 140 beats per minute), chills, decreased blood pressure, thirst, dry mouth, shortness of breath up to 30 - 40 per minute, acrocyanosis, agitation, euphoria with transition to apathy.

With limited posterior mediastinal abscesses, the most common symptom is dysphagia. There may be a dry barking cough up to suffocation (involvement of the trachea), hoarseness of voice (involvement of the recurrent nerve), as well as Horner's syndrome - if the process spreads to the sympathetic nerve trunk. The patient's position is forced, semi-sitting. There may be swelling in the neck and upper chest. On palpation there may be crepitus due to subcutaneous emphysema, as a result of damage to the esophagus, bronchus or trachea.

Local signs: chest pain is the earliest and most persistent sign of mediastinitis. The pain intensifies when swallowing and throwing the head back (Romanov's symptom). The localization of pain mainly reflects the localization of the abscess.

Local symptoms depend on the location of the process.

Anterior mediastinitis	Posterior mediastinitis
Chest pain	Chest pain radiating into the interscapular space
Increased pain when tapping the sternum	Increased pain with pressure on the spinous processes
Increased pain when tilting the head - Gehrke's symptom	Increased pain when swallowing
Pastiness in the sternum area	Pastosity in the area of the thoracic vertebrae
Symptoms of compression of the superior vena cava: headache, tinnitus, cyanosis of the face, swelling of the veins of the neck	Symptoms of compression of the paired and semi-gypsy veins: dilation of the intercostal veins, effusion in the pleura and pericardium
With CT and NMR - a darkened zone in the projection of the anterior mediastinum	With CT and NMR - a darkened zone in the projection of the posterior mediastinum
X-ray - shadow in the anterior mediastinum, presence of air	X-ray - shadow in the posterior mediastinum, presence of air

When treating mediastinitis, active surgical tactics are used, followed by intensive detoxification, antibacterial and immunostimulating therapy. Surgical treatment consists of providing optimal access, exposing the injured area, suturing the rupture, draining the mediastinum and pleural cavity (if necessary) and applying a gastrostomy tube. Mortality in acute purulent mediastinitis is 20-40%. When draining the mediastinum, it is best to use the method of N.N. Kanshin (1973): drainage of the mediastinum with tubular drainages, followed by fractional rinsing with antiseptic solutions and active aspiration.

Chronic mediastinitis divided into aseptic and microbial. Aseptic include idiopathic, posthemorrhagic, coniotic, rheumatic, dysmetabolic. Microbial diseases are divided into nonspecific and specific (syphilitic, tuberculous, mycotic).

What is common to chronic mediastinitis is the productive nature of inflammation with the development of sclerosis of the mediastinal tissue.

Idiopathic mediastinitis (fibrous mediastinitis, mediastinal fibrosis) is of greatest surgical importance. In a localized form, this type of mediastinitis resembles a tumor or mediastinal cyst. In the generalized form, mediastinal fibrosis is combined with retroperitoneal fibrosis, fibrous thyroiditis and orbital pseudotumor.

The clinical picture is determined by the degree of compression of the mediastinal organs. The following compartment syndromes are identified:

Superior vena cava syndrome
Pulmonary vein compression syndrome
Tracheobronchial syndrome
Esophageal syndrome
Pain syndrome
Nerve compression syndrome

Treatment of chronic mediastinitis is mainly conservative and symptomatic. If the cause of mediastinitis is determined, its elimination leads to a cure.

Mediastinal tumors. All clinical symptoms of various mediastinal masses are usually divided into three main groups:

1. Symptoms from the mediastinal organs, compressed by the tumor;

2. Vascular symptoms resulting from compression of blood vessels;

3. Neurogenic symptoms developing due to compression or sprouting of nerve trunks

Compression syndrome manifests itself as compression of the mediastinal organs. First of all, the brachiocephalic and superior vena cava veins are compressed - superior vena cava syndrome. With further growth, compression of the trachea and bronchi is noted. This is manifested by cough and shortness of breath. When the esophagus is compressed, swallowing and passage of food are impaired. When the tumor of the recurrent nerve is compressed, phonation disturbances, paralysis of the vocal cord on the corresponding side. When the phrenic nerve is compressed, the paralyzed half of the diaphragm stands high.

When the borderline sympathetic trunk is compressed, Horner's syndrome causes drooping of the upper eyelid, narrowing of the pupil, and retraction of the eyeball.

Neuroendocrine disorders manifest themselves in the form of joint damage, heart rhythm disturbances, and disturbances in the emotional-volitional sphere.

The symptoms of tumors are varied. The leading role in making a diagnosis, especially in the early stages before the appearance of clinical symptoms, belongs to computed tomography and x-ray methods.

Differential diagnosis of mediastinal tumors themselves.

		Location		Content		Malignancy	Density
Teratoma	The most common tumor of the mediastinum	Anterior mediastinum	Significant	Mucous membrane, fat, hair, organ rudiments	Slow		Elastic
Neurogenic	Second most common	Posterior mediastinum	Significant	Homogeneous	Slow			Fuzzy
Connective tissue	Third most common	Various, most often anterior mediastinum	Various	Homogeneous	Slow
Lipoma, hibernoma		Various	Various	Mixed structure	Slow			Fuzzy
Hemangioma, lymphangioma		Various						Fuzzy

Thymomas (tumors of the thymus) are not classified as mediastinal tumors themselves, although they are considered together with them due to the peculiarities of localization. They can behave both benign and malignant tumors, giving metastases. They develop either from epithelial or lymphoid tissue of the gland. Often accompanied by the development of myasthenia gravis. The malignant variant occurs 2 times more often, is usually very severe and quickly leads to the death of the patient.

Surgical treatment is indicated:

with an established diagnosis and suspicion of a tumor or mediastinal cyst;
for acute purulent mediastinitis, foreign bodies in the mediastinum causing pain, hemoptysis or suppuration in the capsule.

The operation is contraindicated for:

established distant metastases to other organs or cervical and axillary lymph nodes;
compression of the superior vena cava with transition to the mediastinum;
persistent paralysis of the vocal cord in the presence of a malignant tumor, manifested by hoarseness;
dissemination of a malignant tumor with the occurrence of hemorrhagic pleurisy;
the general serious condition of the patient with symptoms of cachexia, hepatic-renal failure, pulmonary and heart failure.

It should be noted that when choosing the scope of surgical intervention in cancer patients, one should take into account not only the growth pattern and extent of the tumor, but also the general condition of the patient, age, and the condition of vital organs.

Surgical treatment of malignant tumors of the mediastinum gives poor results. Hodgkin's disease and reticulosarcoma respond well to radiation treatment. For true mediastinal tumors (teratoblastomas, neuromas, connective tissue tumors), radiation treatment is ineffective. Chemotherapy methods for the treatment of malignant true tumors of the mediastinum are also ineffective.

Purulent mediastinitis requires emergency surgical intervention as the only way to save the patient, regardless of the severity of his condition.

To expose the anterior and posterior mediastinum and the organs located there, various surgical approaches are used: a) complete or partial longitudinal dissection of the sternum; b) transverse dissection of the sternum, in which both pleural cavities are opened; c) both the anterior and posterior mediastinum can be opened through the left and right pleural cavity; d) diaphragmotomy with and without opening the abdominal cavity; e) opening the mediastinum through an incision in the neck; f) the posterior mediastinum can be penetrated extrapleurally from behind along the lateral surface of the spine with resection of the heads of several ribs; g) the mediastinum can be entered extrapleurally after resection of the costal cartilages at the sternum, and sometimes with partial resection of the sternum.

Rehabilitation. Work ability examination.

Clinical examination of patients

To determine the ability of patients to work, general clinical data are used with a mandatory approach to each person examined. During the initial examination, it is necessary to take into account clinical data, the nature of the pathological process - disease or tumor, age, complications from the treatment, and in the presence of a tumor - possible metastasis. It is common to be placed on disability before returning to professional work. For benign tumors after radical treatment, the prognosis is favorable. The prognosis for malignant tumors is poor. Tumors of mesenchymal origin are prone to relapses followed by malignancy.

Subsequently, the radicality of the treatment and complications after treatment are important. Such complications include lymphostasis of the extremities, trophic ulcers after radiation treatment, and disturbances in the ventilation function of the lungs.

Control questions

1. Classification of mediastinal diseases.
2. Clinical symptoms of mediastinal tumors.
3. Methods for diagnosing mediastinal tumors.
4. Indications and contraindications for surgical treatment of tumors and mediastinal cysts.
5. Operative approaches to the anterior and posterior mediastinum.
6. Causes of purulent mediastinitis.
7. Clinic of purulent mediastinitis.
8. Methods for opening ulcers with mediastinitis.
9. Symptoms of esophageal rupture.

10. Principles of treatment of esophageal ruptures.

11. Causes of damage to the thoracic lymphatic duct.

12. Chylothorax clinic.

13. Causes of chronic mediastinitis.

14. Classification of mediastinal tumors.

Situational tasks

1. A 24-year-old patient was admitted with complaints of irritability, sweating, weakness, and palpitations. Ill for 2 years. The thyroid gland is not enlarged. Basic exchange +30%. A physical examination of the patient did not reveal any pathology. An X-ray examination reveals a rounded formation 5x5 cm with clear boundaries in the anterior mediastinum at the level of the second rib on the right, the lung tissue is transparent.

What additional studies are needed to clarify the diagnosis? What is your tactic in treating a patient?

2. Patient, 32 years old. Three years ago I suddenly felt pain in my right arm. She was treated with physiotherapy - the pain decreased, but did not go away completely. Subsequently, I noticed a dense, lumpy formation on the right side of the neck in the supraclavicular region. At the same time, the pain in the right side of the face and neck intensified. At the same time I noticed a narrowing of the right palpebral fissure and a lack of sweating on the right side of the face.

Upon examination, a dense, lumpy, immobile tumor and an expansion of the superficial venous section of the upper half of the body in front were discovered in the right clavicular region. Slight atrophy and decreased muscle strength in the right shoulder girdle and upper limb. Dullness of percussion sound over the apex of the right lung.

What kind of tumor can you think of? What additional research is needed? What's your tactic?

3. Patient, 21 years old. She complained of a feeling of pressure in her chest. Radiologically, on the right, an additional shadow is adjacent to the upper part of the mediastinal shadow in front. The outer contour of this shadow is clear, the inner one merges with the shadow of the mediastinum.

What disease can you think of? What is your tactics in treating the patient?

4. Over the past 4 months, the patient has developed vague pain in the right hypochondrium, accompanied by increasing dysphagic changes. An X-ray examination on the right revealed a shadow in the right lung, which is located behind the heart, with clear contours about 10 cm in diameter. The esophagus at this level is compressed, but its mucous membrane is not changed. Above the compression there is a long delay in the esophagus.

What is your presumptive diagnosis and tactics?

5. A 72-year-old patient immediately after fibrogastroscopy developed substernal pain and swelling in the neck area on the right.

What complication can you think of? What additional studies will you perform to clarify the diagnosis? What is your tactics and treatment?

6. Sick 60 years. A day ago in the hospital, a fish bone was removed at level C 7. After which swelling appeared in the neck area, temperature up to 38°, abundant salivation, palpation on the right began to detect an infiltrate of 5x2 cm, painful. X-ray signs of phlegmon of the neck and expansion of the mediastinal body from above.

What is your diagnosis and tactics?

1. To clarify the diagnosis of intrathoracic goiter, it is necessary to carry out the following additional examination methods: pneumomediastinography - in order to clarify the topical location and size of tumors. Contrast study of the esophagus - to identify dislocation of mediastinal organs and displacement of tumors during swallowing. Tomographic examination - in order to identify narrowing or pushing aside of the vein by a neoplasm; scanning and radioisotope study of thyroid function with radioactive iodine. Clinical manifestations of thyrotoxicosis determine the indications for surgical treatment. Removal of a retrosternal goiter in this location is less traumatic to be carried out using a cervical approach, following the recommendations of V.G. Nikolaev to cross the sternohyoid, sternothyroid, and sternocleidomastoid muscles. If there is a suspicion of fusion of the goiter with surrounding tissues, transthoracic access is possible.

2. You can think about a neurogenic tumor of the mediastinum. Along with a clinical and neurological examination, radiography in direct and lateral projections, tomography, pneumomediastinography, diagnostic pneumothorax, angiocardiopulmography is necessary. In order to identify disorders of the sympathetic nervous system, the Linara diagnostic test is used, based on the use of iodine and starch. The test is positive if, during sweating, starch and iodine react, taking on a brown color.

Treatment of a tumor that causes compression of nerve endings is surgical.

3. You can think about a neurogenic tumor of the posterior mediastinum. The main thing in diagnosing a tumor is to establish its exact location. Treatment consists of surgical removal of the tumor.

4. The patient has a tumor of the posterior mediastinum. The most likely neurogenic character. The diagnosis can be clarified by a multifaceted X-ray examination. At the same time, it is possible to identify the interest of neighboring authorities. Considering the location of the pain, the most likely cause is compression of the phrenic and vagus nerves. Treatment is surgical, in the absence of contraindications.

5. One can think about iatrogenic rupture of the esophagus with the formation of cervical mediastinitis. After an X-ray examination and X-ray contrast examination of the esophagus, an urgent operation is indicated - opening and drainage of the rupture zone, followed by sanitation of the wound.

6. The patient has perforation of the esophagus with subsequent formation of phlegmon of the neck and purulent mediastinitis. Treatment is surgical opening and drainage of neck phlegmon, purulent mediastinotomy, followed by wound sanitation.

The mediastinum is a collection of organs, nerves, lymph nodes and vessels that are located in the same space. In front it is limited by the sternum, on the sides by the pleura (the membrane surrounding the lungs), and behind by the thoracic spine. Below, the mediastinum is separated from the abdominal cavity by the largest respiratory muscle - the diaphragm. There is no border at the top; the chest smoothly passes into the space of the neck.

Classification

For greater convenience in studying the organs of the chest, its entire space was divided into two large parts:

anterior mediastinum;

The front, in turn, is divided into upper and lower. The border between them is the base of the heart.

Also in the mediastinum there are spaces filled with fatty tissue. They are located between the sheaths of blood vessels and organs. These include:

retrosternal or retrotracheal (superficial and deep) - between the sternum and esophagus;
pretracheal - between the trachea and the aortic arch;
left and right tracheobronchial.

Boundaries and main organs

The boundary of the posterior mediastinum is the pericardium and trachea in front, and the anterior surface of the thoracic vertebral bodies in the back.

The following organs are located within the anterior mediastinum:

the heart with a sac surrounding it (pericardium);
upper respiratory tract: trachea and bronchi;
thymus gland or thymus;
phrenic nerve;
the initial part of the vagus nerves;
two sections of the largest vessel of the body - the part and the arch).

The posterior mediastinum includes the following organs:

the descending part of the aorta and the vessels extending from it;
the upper part of the gastrointestinal tract is the esophagus;
part of the vagus nerves located below the roots of the lungs;
thoracic lymphatic duct;
azygos vein;
hemizygos vein;
abdominal nerves.

Features and anomalies of the structure of the esophagus

The esophagus is one of the largest organs of the mediastinum, namely its posterior part. Its upper border corresponds to the VI thoracic vertebra, and the lower border corresponds to the XI thoracic vertebra. This is a tubular organ that has a wall consisting of three layers:

mucous membrane inside;
muscle layer with circular and longitudinal fibers in the middle;
serous membrane from the outside.

The esophagus is divided into cervical, thoracic and abdominal parts. The longest of them is the chest. Its dimensions are approximately 20 cm. At the same time, the cervical region is about 4 cm long, and the abdominal region is only 1-1.5 cm.

Among the malformations of the organ, the most common is esophageal atresia. This is a condition in which the named part of the digestive canal does not pass into the stomach, but ends blindly. Sometimes, with atresia, a connection is formed between the esophagus and the trachea, which is called a fistula.

It is possible to form fistulas without atresia. These passages can occur with the respiratory organs, pleural cavity, mediastinum, and even directly with the surrounding space. In addition to congenital etiology, fistulas form after injuries, surgical interventions, cancer and infectious processes.

Features of the structure of the descending aorta

When considering the anatomy of the chest, you should look at the largest vessel in the body. In the posterior part of the mediastinum is its descending section. This is the third part of the aorta.

The entire vessel is divided into two large sections: thoracic and abdominal. The first of them is located in the mediastinum from the IV thoracic vertebra to the XII. To the right of it is the azygos vein and on the left side is the semi-gypsy vein, in front is the bronchus and the cardiac sac.

It gives two groups of branches to the internal organs and tissues of the body: visceral and parietal. The second group includes 20 intercostal arteries, 10 on each side. Internal ones, in turn, include:

- most often there are 3 of them, which carry blood to the bronchi and lungs;
esophageal arteries - there are from 4 to 7 of them, supplying blood to the esophagus;
vessels supplying blood to the pericardium;
mediastinal branches - carry blood to the lymph nodes of the mediastinum and fatty tissue.

Features of the structure of the azygos and semi-gypsy vein

The azygos vein is a continuation of the right ascending lumbar artery. It enters the posterior mediastinum between the legs of the main respiratory organ - the diaphragm. There, on the left side of the vein, there is the aorta, spine and thoracic lymphatic duct. 9 intercostal veins flow into it on the right side, bronchial and esophageal veins. A continuation of the azygos is the inferior vena cava, which carries blood from the whole body directly to the heart. This transition is located at the level of the IV-V thoracic vertebrae.

The hemizygos vein is also formed from the ascending lumbar artery, only located on the left. In the mediastinum it is located behind the aorta. Then she approaches the left side of the spine. Almost all intercostal veins on the left flow into it.

Features of the structure of the thoracic duct

When considering the anatomy of the chest, it is worth mentioning the thoracic part of the lymphatic duct. This section originates in the aortic opening of the diaphragm. And it ends at the level of the upper thoracic aperture. First, the duct is covered by the aorta, then by the wall of the esophagus. Intercostal lymphatic vessels flow into it from both sides, which carry lymph from the back of the chest cavity. It also includes the bronchomediastinal trunk, which collects lymph from the left side of the chest.

At the level of the II-V thoracic vertebrae, the lymphatic duct sharply turns to the left and then approaches the VII vertebra of the cervical spine. On average, its length is 40 cm, and the width of the lumen is 0.5-1.5 cm.

There are different options for the structure of the thoracic duct: with one or two trunks, with a single trunk that bifurcates, straight or with loops.

Blood enters the duct through the intercostal vessels and esophageal arteries.

Features of the structure of the vagus nerves

The left and right vagus nerves of the posterior mediastinum are distinguished. The left nerve trunk enters the space of the chest between two arteries: the left subclavian and the common carotid. The left recurrent nerve departs from it, bending around the aorta and tending to the neck area. Further, the vagus nerve goes behind the left bronchus, and even lower - in front of the esophagus.

The right vagus nerve is first placed between the subclavian artery and vein. The right recurrent nerve departs from it, which, like the left, approaches the space of the neck.

The thoracic nerve gives off four main branches:

anterior bronchial - part of the anterior pulmonary plexus along with the branches of the sympathetic trunk;
posterior bronchial - are part of the posterior pulmonary plexus;
to the cardiac sac - small branches carry a nerve impulse to the pericardium;
esophageal - form the anterior and posterior esophageal plexuses.

Mediastinal lymph nodes

All lymph nodes located in this space are divided into two systems: parietal and visceral.

The visceral system of lymph nodes includes the following formations:

anterior lymph nodes: right and left anterior mediastinal, transverse;
posterior mediastinal;
tracheobronchial.

When studying what is in the posterior mediastinum, it is necessary to pay special attention to the lymph nodes. Since the presence of changes in them is a characteristic sign of an infectious or cancerous process. Generalized enlargement is called lymphadenopathy. It can occur for a long time without any symptoms. But prolonged enlargement of the lymph nodes eventually makes itself felt with the following disorders:

loss of body weight;
lack of appetite;
increased sweating;
high body temperature;
sore throat or pharyngitis;
enlarged liver and spleen.

Not only medical workers, but also ordinary people should have an idea of the structure of the posterior mediastinum and the organs that are located in it. After all, this is a very important anatomical formation. Violation of its structure can lead to serious consequences requiring the help of a specialist.