Mediastinum
In tension, the mediastinum is shifted and the diaphragm is flattened.
What our notes say
- In tension, the mediastinum is shifted and the diaphragm is flattened. (Pneumothorax)
- The mediastinum is pushed away (to the left), a TB effusion is an exudate (protein above 3 g/dL), a heart failure effusion is a transudate, and chest tubes are used at any age. (Paediatrics end of fourth year main exam: 1 July 2019, Paper One, 99 of 100 MCQs)
- If the area anterior and superior to the heart is opacified, it suggests disease in the anterior mediastinum or upper lobes. (Examination of Respiratory system — Past Paper Questions & Answers)
- A chest radiograph shows that the mediastinum is shifted to the left, and there are no fractures. (Respiratory system pathology mcqs — Past Paper Questions & Answers)
- Signs: stony dull percussion, reduced or absent breath sounds, reduced tactile vocal fremitus over the effusion; bronchial breathing at the upper edge; trachea and mediastinum pushed away if large; reduced chest expansion. (Pleural Effusion)
- • Can be due to conditions of:- the heart, lungs, pleura, thoracic cage, mediastinum and abdomen (Cardiovascular system examination revised 2012 — Past Paper Questions & Answers)
Study material on Mediastinum
- Examination of Respiratory system
- Master First-Year Anatomy: Must-Know Essays & Key Concepts
- Chest X-ray Interpretation Guide: ABCDE Approach for Medical Students
- Cardiovascular system examination revised 2012
Practice questions on Mediastinum
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. What is the most likely diagnosis?
- Myocardial infarction
- Aortic dissection
- Pulmonary embolism
- Esophageal rupture
Answer: B. Sudden, severe, tearing chest pain radiating to the back, a history of hypertension, and a widened mediastinum on CXR are classic signs of aortic dissection. Normal CK rules out acute MI.
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. Most likely diagnosis?
- Aortic dissection
- Pulmonary embolism
- Myocardial infarction
- Esophageal rupture
Answer: A. Sudden onset severe chest pain radiating to the back, history of hypertension, and widened mediastinum on CXR are classic signs of aortic dissection. Normal CK rules out myocardial infarction. Esophageal rupture typically presents with more vomiting or retroperitoneal air.
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. What is the most likely diagnosis?
- Myocardial infarction
- Pulmonary embolism
- Aortic dissection
- Pericarditis
Answer: C. Sudden, severe chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR are classic signs of aortic dissection. Normal CK rules out myocardial infarction as the primary event.
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. Most likely diagnosis?
- Aortic dissection
- Myocardial infarction
- Pulmonary embolism
- Esophageal rupture
Answer: A. The classic presentation of sudden, severe chest pain radiating to the back, associated with hypertension and a widened mediastinum on imaging, strongly suggests aortic dissection. Normal CK levels help rule out myocardial infarction.
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. Most likely diagnosis?
- Myocardial infarction
- Pulmonary embolism
- Aortic dissection
- Pericarditis
Answer: C. Sudden, severe, 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR are classic signs of aortic dissection. Normal CK levels rule out myocardial infarction as the primary cause of chest pain.
A 63-year-old woman has sudden 'knife-like' chest pain radiating to the back, poorly controlled hypertension, and a widened mediastinum on CXR. CK is normal. Most likely diagnosis?
- Aortic dissection
- Myocardial infarction
- Pulmonary embolism
- Esophageal rupture
Answer: A. Sudden, severe, 'knife-like' chest pain radiating to the back, associated with poorly controlled hypertension and a widened mediastinum on CXR, is highly suggestive of aortic dissection. Normal CK levels rule out myocardial infarction as the primary cause of the chest pain.