Mediastinal dullness circle enlargement

Introduction Usually caused by inflammation of the mediastinum, the longitudinal turbidity sounds are enlarged. It is one of the signs of mediastinal inflammation. Mediastinal inflammation refers to bacterial infection in the mediastinum, which is divided into acute and chronic acute mediastinal inflammation to form abscesses, and the condition is serious. Chronic mediastinal inflammation is mostly granuloma-like, often caused by primary tuberculosis or histoplasmosis caused by slow onset, often asymptomatic, found on X-ray examination, a small number of patients can also occur due to blockage or compression caused by lesions Corresponding symptoms and signs.

Cause

It is known that tuberculosis, histoplasmosis, actinomycetes, sarcoidosis, syphilis, post-traumatic mediastinal hemorrhage, and drug poisoning can cause mediastinal fibrosis. It may also be related to autoimmunity.

Clinically, the most common causes are secondary chest trauma, esophageal or tracheal rupture, swallowing foreign body caused by esophageal perforation, esophageal surgery after anastomotic esophagoscopy, traumatic perforation and esophageal cancer ulcers, etc. It may also be caused by the spontaneous spread of infections in occasional adjacent tissues such as the esophageal sac, the lung, and the pleural lymph nodes of the pleural cavity.

an examination

Related inspection

Thoracic plain film chest external examination lung and pleural pericardial chest MRI

Laboratory inspection

Blood examination showed an increase in white blood cell count and neutrophil classification in the acute phase, and normal blood levels in the chronic phase. The mediastinal drainage fluid is cultured to obtain pathogenic bacteria, and the drug sensitivity test is used to guide the selection of therapeutic drugs.

Film degree exam

Chest X-ray examination:

(1) Acute mediastinal inflammation: the double mediastinum is widened and blurred, and the posterior sternal density increases. Abscess formation can be seen on one or both sides of the mediastinum with prominent shadows. The trachea and esophagus are displaced by pressure. The mediastinal fluid surface and mediastinal fluid accumulation can also be seen.

(2) Chronic mediastinal inflammation: mediastinal pleural hypertrophy and widening, calcification, airway and esophageal pressure displacement. Mediastinal CT and magnetic resonance imaging are more valuable for this disease.

Other inspection

Mediastinoscopy and biopsy: mediastinal examination with unclear lesions and biopsy contribute to the qualitative and differential diagnosis of chronic mediastinal inflammation.

Differential diagnosis

It should be differentiated from the following symptoms:

1. Mediastinal lesions:

Mediastinal diseases include mediastinal tumors (benign and malignant), cysts, acute and chronic mediastinal inflammation, mediastinal spasm, mediastinal emphysema, etc.

The chest cavity of the human body is divided into two pleural cavities, and the middle part of the pleural cavity on both sides is called the mediastinum. The mediastinum contains the heart, large blood vessels in the chest, trachea, esophagus, nerves and lymphoid tissues. The mediastinum can be divided into several regions, from the sternal angle (ie, the intersection of the sternum stem and the sternum body, which can be touched on the body surface to show a distinct transverse sac), and the horizontal line is drawn backward to the lower edge of the fourth thoracic vertebral body. Above the line is called the upper mediastinum, and the line is called the lower mediastinum. The upper mediastinum is bounded by the trachea, the front is the anterior superior mediastinum, and the posterior is the posterior superior mediastinum. The lower mediastinum is divided into three parts: the front, the middle and the back. The front of the pericardium is the anterior mediastinum. The pericardium is called the mediastinum. The posterior mediastinum is called between the pericardium and the spine.

The anterior superior mediastinum mainly has thymus and intrathoracic thyroid gland. The posterior superior mediastinum has trachea, esophagus, aortic arch and its three head-arm vascular branches, thoracic duct, vagus, nerve and so on. The lower anterior mediastinum has a lower thymus, lymph nodes, fat and connective tissue. The posterior mediastinum has esophagus, thoracic duct, descending aorta and its branches, azygous veins, semi-odd veins, vagus and sympathetic nerves.

2. Mediastinal fibrosis:

Chronic mediastinal inflammation, also known as idiopathic mediastinal fibrosis, is more complicated. Chronic mediastinal inflammation can lead to obstruction of the superior vena cava, and patients have a series of signs of symptoms of superior vena cava obstruction.

3. Mediastinum widening:

Mediastinal inflammation, hematoma, abscess, paratracheal lymphadenopathy, mediastinal tumor and cyst, superior vena cava and azygotic vein dilatation, aneurysm, mediastinal pleural effusion, etc. can widen the mediastinum, combined with clinical and medical history, if necessary Methods such as tomography and angiography are used to determine the reason for the widening.

diagnosis:

In addition to the medical history, the diagnosis is mainly based on clinical manifestations, but due to a part of the whole process of mediastinal inflammation, and simple mediastinal inflammation on the chest X-ray, except for the possibility of mediastinal shadow widening and mediastinal emphysema, there is no special performance, so the clinical Most of the above-mentioned mediastinal abscesses are seen, or the posterior mediastinum has a gas-liquid surface or a pneumothorax on the lateral chest radiograph. Sometimes it is not easy to diagnose. The posterior and lateral chest radiographs are important for X-ray examination. Generally, bedside photography is not clear due to the relationship of shooting conditions. For the convenience of diagnosis, it is best to take a chest position and a lateral chest piece after the semi-sitting position. If the esophagus or trachea is suspected to be ruptured, 40% sterile iodized oil can be used to avoid sputum, so as to avoid long-term retention and stimulate the tissue.

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