Download - 15. Mediastinal Syndromes
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MEDIASTINAL
SYNDROMES
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MEDIASTINUM
TOPOGRAPHIC REGION THAT
SERVES AS A PASSING CHANNEL FOR
SOME ANATOMICAL ELEMENTS OF
VITAL IMPORTANCE
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MEDIASTINUM
BORDERS
SUP THORACIC INLET T1 C1
LAT PLEURA
POST SPINE
ANT STERNUM
INF DIAPHRAGM
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MEDIASTINUM- CONTENTS
RESPIRATORY system
DIGESTIVE system ESOPHAGUS
CARDIOVASCULAR system
TRACHEA
MAJOR BRONCHI
PLEURA
HEART
PERICARDUM
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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
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MEDIASTINUM - CONTENTS
LYMPHATICS
THORACIC DUCT
LYMPH NODES
ANTERO-SUPERIOR group
MIDDLE group
POSTERIOR group
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MEDIASTINUM - CONTENTS
NERVES
VAGUS (POSTERIOR MEDIASTINUM)
LEFT RECURRENT LARYNGEAL
RIGHT RECURRENT LARYNGEAL
PHRENICS
ANTERIOR MEDIASTINUM
OVER THE LEFT VENTRICLE
SYMPATHETICS CHAINS
INTERCOSTALS
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MEDIASTINUM - CONTENTS
ENDOCRINE glands
THYMUS
THIROID
PARATHYROIDS
ADIPOSE AND CONJUNCTIVE TISSUE
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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
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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
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MEDIASTINUM COMPARTMENTS POSTERIOR (PARAVERTEBRAL)
ESOPHAGUS
VAGUS NERVE
THORACIC DUCT
ASCENDENT AORTA
SYMPATHETICS CHAINS
POSTERIOR MEDIASTINAL LYMPH NODES
INTERCOSTAL NERVES
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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
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MEDIASTINUM SEMIOLOGY
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
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VASCULAR
ARTERIAL
AORTIC PULSATION in STERNOCLAVICULAR AREA
DIMINISHED/ABOLISHED RADIAL PULSE (subclavian compression)
PULSUS PARADOXUS (aortic compression)
OLIVER CARDARELLI sign
ARTERIAL MURMURS
MEDIASTINUM SEMIOLOGY
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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
MEDIASTINUM SEMIOLOGY
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SUPERIOR CAVA VEIN COMPRESSION SYNDROME
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SUPERIOR CAVA VEIN COMPRESSION SYNDROME
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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
MEDIASTINUM SEMIOLOGY
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ENDOCRINE
INTRATHORACIC GOITER HYPO/HYPERfunction
PARATHIROID HYPERPARATHIROIDISM
THYMUS MIASTENIA GRAVIS
CONJUNCTIVE TISSUE
SUPPURATIONS
PNEUMOMEDIASTINUM
MEDIASTINUM SEMIOLOGY
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INTRATHORACIC GOITER
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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
MEDIASTINUM SEMIOLOGY
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NERVES
MEDIASTINUM SEMIOLOGY
IRITATION PARALYSIS
VAGUS
BRONCHOSPASM
ESOPHAGIAN SPASM
BRADYCARDIA
TACHYCARDIA
PHRENIC HICCUPS DIAPHRAGM
HYPOTONIA
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NERVES
INTERCOSTAL NEURALGIA
CERVICAL SYMPATHETIC CHAIN lesion
sd. CLAUDE-BERNARD-HORNER
MIOSIS
PALPEBRAL PTOSIS
ENOPHTALMOS
CERVICO BRACHIAL NEURALGIA
MEDIASTINUM SEMIOLOGY
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CLINICAL EXAMINATION FINDINGS
INSPECTION
ADENOPATHIC THORAX
RETRACTION
COLATERALL CIRCULATION
JUGULAR VEINS DISTENSION
SWELLING
PALPATION
SENSIBILITY
PECTORAL FREMITUS CHANGES
MEDIASTINUM SEMIOLOGY
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MODIFICARI LA EXAMENUL OBIECTIV
PERCUTION
PARAMANUBRIAL DULLNESS
INTERSCAPULARVERTEBRAL DULLNESS
C7 T4 DULLNESS
AUSCULTATION
LOCALISED DIMINISHED/ABOLISHED BREATH SOUNDS
BRONCHIAL SOUND
VERTEBRAL BRONCHOPHONY
PECTORILOQUI
MEDIASTINUM SEMIOLOGY
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RADIOLOGY and COMPUTED TOMOGRAPHY
Establish the diagnostic
WIDENED mediastinal shadow (esp. in the superior region)
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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
MEDIASTINUM SEMIOLOGY
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WIDENED MEDIASTINUM
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MEDIASTINAL LYMPHADENOPATHY
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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
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MEDIASTINAL SYNDROMES
MIDDLE MEDIASTINAL Sd.
BRONCHO-RECURRENTAL
AORTIC ARCH ANEURYSM
CAUSIS
BRONCHOPULMONARY CANCER
METASTASIS
LYMPHOMA
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MEDIASTINAL SYNDROMES
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
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MEDIASTINAL SYNDROMES
ACUTE MEDIASTINITIS
ACUTE MEDIASTINAL SUPPURATION
MEDIASTINAL ABSCESS
MEDIASTINAL PLEURAL EFFUSION szma
CLINICAL:
PAIN
INFECTIOUS sign
DYSPNEA nefes darl
DYSPHAGIA yutkunma zorluu
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MEDIASTINAL SYNDROMES
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
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MEDIASTINAL SYNDROMES
MEDIASTINAL HEMORRAGES
AORTIC DISSECTION
ANEURYSM RUPTURE
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