A Modern Definition of Mediastinal Compartments

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Presentation transcript:

A Modern Definition of Mediastinal Compartments Brett W. Carter, MD, Noriyuki Tomiyama, MD, Faiz Y. Bhora, MD, Melissa L. Rosado de Christenson, MD, Jun Nakajima, MD, Phillip M. Boiselle, MD, Frank C. Detterbeck, MD, Edith M. Marom, MD Journal of Thoracic Oncology Volume 9, Issue 9, Pages S97-S101 (September 2014) DOI: 10.1097/JTO.0000000000000292 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Coned-down contrast-enhanced axial CT images slightly below the aortic arch (A), at the level of the left pulmonary artery (B), and at the level of the left atrium (C) demonstrate the proposed classification scheme. Red, prevascular compartment; green, visceral compartment; yellow, paravertebral compartment; blue line, visceral–paravertebral compartment boundary line. Journal of Thoracic Oncology 2014 9, S97-S101DOI: (10.1097/JTO.0000000000000292) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Sagittal reformatted image from contrast-enhanced CT demonstrates the proposed classification scheme. It is important to note that the prevascular compartment wraps around the heart and pericardium in the visceral compartment. Red, prevascular compartment; green, visceral compartment; yellow, paravertebral compartment; blue line, visceral–paravertebral compartment boundary line. Journal of Thoracic Oncology 2014 9, S97-S101DOI: (10.1097/JTO.0000000000000292) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Representative examples of mediastinal masses. (A) Coned-down contrast-enhanced axial CT image shows a large heterogeneous mass (M) in the prevascular compartment consistent with a biopsy-proven thymoma. Note the posterior displacement of the heart and great vessels, confirming its anterior location. A left pleural effusion (E) and right pleural nodules (arrows) represent pleural dissemination. (B) Coned-down contrast-enhanced axial CT image shows a low attenuation mass (M) located between the left atrium and the thoracic spine, confirming its location in the visceral compartment. Endoscopic biopsy revealed esophageal cancer. (C) Coned-down contrast-enhanced axial CT image shows a low attenuation mass (M) located within the left atrium in this patient with an angiosarcoma. The intracardiac location of this lesion confirms its location in the visceral compartment. (D) Coned-down contrast-enhanced axial CT image shows a large mass (M) with calcifications in the left mediastinum. The mass displaces organs of the visceral compartment such as the heart anteriorly and the central portion of the lesion is localized to the paravertebral region; thus the origin of this mass is in the paravertebral compartment. CT-guided biopsy demonstrated ganglioneuroma. Journal of Thoracic Oncology 2014 9, S97-S101DOI: (10.1097/JTO.0000000000000292) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions