Initial approach to mediastinal alterations: Review of their radiographic anatomical references

Emmanuel Salinas Miranda, Luisa Karen Cifuentes, Juan Gonzalo Vélez, Bibiana Andrea Pinzón

Article ID: 1716
Vol 2, Issue 1, 2019

VIEWS - 740 (Abstract) 661 (PDF)


The suspicion of mediastinal alterations, always includes in its initial study, the chest radiography. The identification of mediastinal alterations in the X-ray is a priority. The knowledge of the mediastinal references and the identification of their alterations allows the suspicion of a pathology specific to each of the mediastinal spaces. When the semiology of mediastinal lesions, their location and the three most frequent pathologies are taken into account, the possibility of having an etiological diagnosis increases[1]. This is a review article based on a detailed literature search, in which radiological mediastinal references are studied, with emphasis on the epidemiological data of each one of them.


Epidemiology; Surgery; Radiography; Tumors; Evidence-based Medicine

Full Text:



1. Proto AV. Mediastinal anatomy: Emphasis on conventional images with anatomic and computed tomographic correlations. Journal of Thoracic Imaging 1987; 2: 1–48.

2. Gibbs JM, Chandrasekhar CA, Ferguson EC, et al. Lines and stripes: Where did they go—From Conventional Radiography to CT. RadioGraphics 2007; 27: 33–48.

3. Heitzman ER. The mediastinum: Radiologic correlations with anatomy and pathology. 2nd ed. Berlin: Springer; 2012. p. 355.

4. Dobson MJ, Carrington BM, Parsons VJ, et al. What is the value of the lateral chest radio- graph in the follow-up thoracic lymphoma? European Radiology 1997; 7: 1110–1113.

5. Panikkath R, Panikkath D. Mach band sign: An optical illusion. Baylor University Medical Center Proceedings 2014; 27: 364–365.

6. Chasen MH. Practical applications of Mach band theory in thoracic analysis. Radiology 2001; 219: 596–610.

7. Gunn ML (editor). Pearls and pitfalls in emergency radiology: Variants and other difficult diagnoses [Internet]. 2013. Available from:

8. Sinnatamby C. Last’s anatomy: Regional and applied. Australia: Elsevier; 2003.

9. Zylak CJ, Pallie W, Pirani M, et al. Anatomy and computed tomography. RadioGraphics 1983; 3: 478–530.

10. Fraser RS, Müller NL, Colman N, et al. Fraser and Paré’s diagnosis of diseases of the chest [Internet]. 1999. Available from:

11. Fujimoto K, Hara M, Tomiyama N, et al. Proposal for a new mediastinal compartment classification of transverse plane images according to the Japanese Association for Research on the Thymus (JART) General Rules for the Study of Mediastinal Tumors. Oncology Reports 2014; 31: 565–572.

12. Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. Journal of Thoracic Oncology 2014; 9: S97–S101.

13. Takeda S, Miyoshi S, Akashi A, et al. Clinical spectrum of primary mediastinal tumors: A comparison of adult and pediatric populations at a single Japanese institution. Journal of Surgical Oncology 2003; 83: 24–30.

14. Aroor AR. A study of clinical characteristics of mediastinal mass. Journal of Clinical and Diagnostic Research 2014; 8(2): 77–80.

15. Coche EE, Ghaye B, Mey JD, et al. Comparative interpretation of CT and standard radiography of the chest. Secaucus: Springer Science & Business Media; 2011.

16. Giron J, Fajadet P, Sans N, et al. Diagnostic approach to mediastinal masses. European Journal of Radiology 1998; 27: 21–42.

17. McComb BL. Reflecting upon the left superior mediastinum. Journal of Thoracic Imaging 2001; 16: 56–64.

18. Wright FW. Radiology of the chest and related conditions. Boca Raton: CRC Press; 2001.

19. Webb WR, Higgins CB. Thoracic imaging: Pulmonary and cardiovascular radiology. Philadelphia: Lippincott Williams & Wilkins; 2010.

20. Hansell DM. Imaging of diseases of the chest: Expert consult—Online and print. 5th ed. Edinburgh: Mosby; 2009.

21. Lai V, Tsang WK, Chan WC, et al. Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection. Emergency Radiology 2012; 19: 309–315.

22. Lai V, Tsang WK, Chan WC, et al. Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection. Emergency Radiology 2012; 19: 309–315.

23. Naidich DP, Müller NL, Webb WR. Computed tomography and magnetic resonance of the thorax. Philadelphia: Lippincott Williams & Wilkins; 2007.

24. Suwatanapongched T, Gierada DS. CT of thoracic lymph nodes. Part II: Diseases and pitfalls. British Journal of Radiology 2006; 79: 999–1000.

25. Swingler G, du Toit G, Andronikou S, et al. Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis. Archives of Disease in Childhood 2005; 90: 1153–1156.

26. Don CJ, Dales RE, Desmarais RL, et al. The radiographic prevalence of hilar and mediastinal adenopathy in adult cystic fibrosis. Canadian Association of Radiologists Journal 1997; 48: 265–269.

27. Costa NS, Laor T, Donnelly LF. Superior cervical extension of the thymus: A normal finding that should not be mistaken for a mass. Radiology 2010; 256: 238–242.

28. Kar P, Rath GP, Prabhakar H, et al. Tracheal deviation may be a normal anatomical variant in children. Anaesthesia and Intensive Care 2009; 37: 144–145.

29. Scaglione M, Romano S, Pinto A, et al. Acute tracheobronchial injuries: Impact of imaging on diagnosis and management implications. European Journal of Radiology 2006; 59: 336–343.

30. Unger JM, Schuchmann GG, Grossman JE, et al. Tears of the trachea and main bronchi caused by blunt trauma: Radiologic findings. American Journal of Roentgenology 1989; 153: 1175–1180.

31. Hong BW, Mazeh H, Chen H, et al. Routine Chest X-ray prior to thyroid surgery: Is it always necessary? World Journal of Surgery 2012; 36: 2584–2589.

32. Adegboye VO, Brimmo AI, Adebo OA, et al. The place of clinical features and standard chest radiography in evaluation of mediastinal masses. West African Journal of Medicine 2003; 22: 156–160.

33. Díez JJ. Goiter in adult patients aged 55 years and older: Etiology and clinical features in 634 patients. The Journals of Gerontology: Series A 2005; 60: 920–923.

34. Buckley JA, Stark P. Intrathoracic mediastinal thyroid goiter: Imaging manifestations. American Journal of Roentgenology 1999; 173: 471–475.

35. Van Beek EJR, Been HD, Ponsen K-J, Maas M. Upper thoracic spinal fractures in trauma patients—A diagnostic pitfall. Injury 2000; 31: 219–223.

36. Yang DH, Seo JB, Lee IS, et al. Displaced aortic arch sign on chest radiographs: A new sign for the detection of a left paratracheal esophageal mass. European Radiology 2004; 15: 936–940.

37. Takahashi K, Shinozaki T, Hyodo H, et al. Focal obliteration of the descending aortic interface on normal frontal chest radiographs: Correlation with CT findings. Radiology 1994; 191: 685–690.

38. Marchiori D. Clinical imaging: With skeletal, chest and abdomen pattern differentials. United Kingdom: Elsevier Health Sciences; 2004.

39. Heitzman ER, Groskin SA. The lung: Radiologic-pathologic correlations. 3rd edition. St. Louis: Mosby; 1993.

40. Franquet T, Erasmus JJ, Giménez A, et al. The retrotracheal space: Normal anatomic and pathologic appearances. RadioGraphics 2002; 22(S1): 231–246.

41. Webb WR, Hirji M, Gamsu G. Posterior wall of the bronchus intermedius: Radiographic-CT correlation. American Journal of Roentgenology 1984; 142: 907–911.

42. Frija J, de Kerviler E, Zagdanski AM. Radiologic anatomy of the inferior lung margins as demonstrated on computed radiography with enhancement of low frequencies. Surgical and Radiologic Anatomy 1997; 19: 257–263.

43. Biemans JMA, Van Heesewijk JPM, Van Der Graaf Y. Digital chest imaging: Selenium radiography versus storage phosphor imaging. Comparison of visualization of specific anatomic regions of the chest. Investigative Radiology 2002; 37: 47–51.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License

This site is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.