Disorders of the Pleura, Mediastinum, and Hilum

Abstract

The pleura are a composition of two serous membranes: the visceral pleura lining the lungs and the parietal pleura lining the inner chest wall, diaphragm, and mediastinum. The pulmonary hilum is composed of blood vessels, airways, nerves, and lymph nodes and denotes the meeting point between the mediastinum and the pleural cavities. This review covers disorders of the pleura, mediastinum, and hilum. Figures show a schematic diagram of normal filtration/resorption of fluid in the pleural space; comparison of a simultaneously obtained chest x-ray (CXR) and a chest computed tomographic (CT) scan of the same patient; an algorithm for evaluation of patients with pleural effusion (PE); a three-compartment model of mediastinal anatomy; photographs of a resected, well-encapsulated thymoma and a benign, multiloculated thymic cyst that were completely removed by sternotomy, a resected esophageal duplication cyst, and an esophageal leiomyoma being removed by means of a right thoracotomy; CT scans demonstrating the characteristic appearance of an invasive thymoma, an extragonadal germ cell tumor, a primary mediastinal B cell lymphoma, a goiter with extension behind the trachea, right paratracheal adenopathy in the middle mediastinal compartment, a middle mediastinal cystic mass, a large subcarinal bronchogenic cyst, a tracheal chondrosarcoma, gas in the mediastinum due to esophageal perforation, and mediastinal fibrosis; coronal imaging showing a large, smooth muscle tumor associated with the distal esophagus; a barium swallow showing a large esophageal perforation that resulted in soilage of the middle mediastinum; and posteroanterior and lateral CXRs of a posterior mediastinal neurogenic tumor accompanied by a CT scan showing the posterior mediastinal neurogenic tumor visualized in the posteroanterior radiograph.  This review contains 19 figures, 51 tables, and 83 references. Keywords:  Mediastinum, mediastinitis, pleural effusion, empyema, congestive heart failure, adenopathy, thymoma, esophageal perforation