126 |
6 Abnormal Mediastinum |
Fig. 6.2a Subtle mediastinal mass in the left medial chest, adjacent to the descending aortic edge
Fig. 6.2b Posterior mediastinal mass circled
Mediastinal Enlargement
The mediastinum can be enlarged from mass; however, one should also consider vessels, blood, or fluid. See Fig. 6.3 for CXR and CT of enlarged irregular mediastinum compatible with a ruptured aortic aneurism.
Mediastinal Enlargement |
127 |
Fig. 6.2c Mediastinal mass confirmed posterior and esophageal on CT. The low density mass is between the descending aorta and the heart
Fig. 6.3a This portable CXR demonstrated a widened mediastinum
Case 6.3
The CXR in Fig. 6.3 is a case of a 50-year-old presenting with acute chest pain. Findings: AP chest demonstrates grossly widened and ill-defined mediastinum.
Of note, the aortic calcification is not seen in the periphery of the aortic knob, indicating bleeding outside the aorta.
Location: Anterior middle and posterior mediastinum.
128 |
6 Abnormal Mediastinum |
Fig. 6.3b Same image, now with arrows (large) highlighting the widened mediastinum. Note the aortic calcifications (small arrows) that are usually on the periphery of the aortic knob on the CXR
Fig. 6.3c An emergently ordered axial CT of the same patient and shows the active bleeding (small arrows on d) and less acute blood (large arrows) causing the widening seen on the CXR