Mediastinum

The mediastinum is the space in the upper chest between your breast bone and spinal column. It contains the swallowing tube (esophagus), windpipe (trachea), heart, and other important structures. The lungs are behind the mediastinum.

Tumors, masses, and cysts may form in this space. The appropriate treatment for mediastinal tumors depends on the type and location. Sometimes, a minimally invasive operation is selected. Other tumors are best treated with an open approach or with additional chemotherapy or radiation.

Conditions of the Mediastinum

Bronchogenic Cysts

Bronchogenic cysts occur in the middle mediastinum and are benign, fluid filled cysts, which may become infected. They usually should be removed.

Mediastinal Germ Cell Tumor

Malignant mediastinal germ-cell tumors are relatively rare. Often, they are large enough to cause symptoms because they'll invade or compress other areas such as the lungs, pericardium, and chest wall.

They are treated with a combination of chemotherapy, surgery, and radiation.

Myasthenia Gravis (MG)

Myasthenia gravis (MG) is an autoimmune disorder that causes muscle fatigue from the effects of abnormal antibodies on nerve endings.

MG may be associated with various abnormalities of the thymus gland, which lies behind the breastbone. This possible association has led physicians to recommend that the gland be removed (thymectomy).

Neurogenic tumors

Neurogenic tumors form in the posterior mediastinum and are usually benign in adults. Some, if small enough, can be removed by minimally invasive techniques.

Surgical Procedures

Mediastinoscopy

In a mediastinoscopy, a surgeon uses a thin scope called a mediastinoscope to examine the mediastinum. The procedure is often used to check for problems in the upper chest or to check lymph nodes in the mediastinum before considering lung removal surgery to treat lung cancer or to diagnose certain infections.

The surgery involves making an incision at the base of your neck, just above the breastbone or on the left side of your chest between the ribs. The scope is then inserted to allow the surgeon to see inside the area. When everthing is done, you'll get a few stitches and a small bandage.

Thymectomy

Removal of the thymus can sometimes be done with a procedure called minimally invasive transcervical thymectomy. With it, a horizontal incision is made across the lower part of your neck. Then, a scope is inserted to let the surgeon see the gland. A small drain is left in the incision for a couple of days.

This technique is associated with the least amount of pain and has the shortest recovery period. It is important to note that it may not be recommended for every patient. Some patients require thymectomy by the traditional route through the breastbone.

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