2. Mediastinum and Pericardium
A. Anatomy, Physiology and Embryology
Objectives: This section teaches the student; the anatomy, physiology and embryology of the mediastinum and pericardium, the relationships of adjacent structures, and applies findings of invasive and non-invasive tests to patient management.
1. Understands the anatomic boundaries of the mediastinum and the structures found within each region.
2. Understands the embryologic development of structures within the mediastinum and the variations and pathologic consequences of abnormally located structures.
3. Understands the radiologic assessment of the mediastinum including CT scan, MRI, contrast studies, and angiography.
4. Understands pericardial pathology and it’s effect on cardiac physiology.
Contents:
1. Anterior mediastinum a. Major structures
b. Diagnostic studies
2. Middle mediastinum (visceral compartment)
a. Major structures
b. Diagnostic studies
3. Posterior mediastinum (paravertebral sulcus)
a. Major structures
b. Diagnostic studies
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Able to read and interprets mediastinal plain radiographs, CT scans, MRI, and contrast studies;
2. Able to apply knowledge of mediastinal anatomy and physiology to the diagnosis of mediastinal abnormalities.
3. Able to apply knowledge of pericardial physiology to the differential diagnosis of pericardial vs. myocardial abnormalities.
1. Understands the anatomic boundaries of the mediastinum and the structures found within each region.
2. Understands the embryologic development of structures within the mediastinum and the variations and pathologic consequences of abnormally located structures.
3. Understands the radiologic assessment of the mediastinum including CT scan, MRI, contrast studies, and angiography.
4. Understands pericardial pathology and it’s effect on cardiac physiology.
Contents:
1. Anterior mediastinum a. Major structures
b. Diagnostic studies
2. Middle mediastinum (visceral compartment)
a. Major structures
b. Diagnostic studies
3. Posterior mediastinum (paravertebral sulcus)
a. Major structures
b. Diagnostic studies
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Able to read and interprets mediastinal plain radiographs, CT scans, MRI, and contrast studies;
2. Able to apply knowledge of mediastinal anatomy and physiology to the diagnosis of mediastinal abnormalities.
3. Able to apply knowledge of pericardial physiology to the differential diagnosis of pericardial vs. myocardial abnormalities.
B. Congenital Abnormalities of the Mediastinum
Objective: This section teaches the student; congenital mediastinal abnormalities and performs operative and non-operative management.
1. Is able to diagnose mediastinal cysts.
2. Is familiar with the symptoms associated with mediastinal abnormalities.
3. Knows the indications for operations involving the mediastinum and the anatomic approaches.
Contents:
1. Mediastinal cysts
a. Anterior
1. Cystic hygroma
b. Middle
1. Pericardial cysts
2. Bronchogenic cysts
c. Posterior
1. Esophageal duplications
2. Neurogenic tumors
2. Symptoms of mediastinal abnormalities
3. Management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Able to read and interprets plain radiographs, CT scans, MRI's and contrast studies of congenital abnormalities of the mediastinum.
2. Able to diagnoses and manages patients with congenital abnormalities of the mediastinum.
3. Assists/Performs (2/0) operations for congenital abnormalities of the mediastinum.
1. Is able to diagnose mediastinal cysts.
2. Is familiar with the symptoms associated with mediastinal abnormalities.
3. Knows the indications for operations involving the mediastinum and the anatomic approaches.
Contents:
1. Mediastinal cysts
a. Anterior
1. Cystic hygroma
b. Middle
1. Pericardial cysts
2. Bronchogenic cysts
c. Posterior
1. Esophageal duplications
2. Neurogenic tumors
2. Symptoms of mediastinal abnormalities
3. Management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Able to read and interprets plain radiographs, CT scans, MRI's and contrast studies of congenital abnormalities of the mediastinum.
2. Able to diagnoses and manages patients with congenital abnormalities of the mediastinum.
3. Assists/Performs (2/0) operations for congenital abnormalities of the mediastinum.
C. Acquired Abnormalities of the Mediastinum
Objectives: This section teaches the student; the differential diagnosis of mediastinal abnormalities and performs operative and non-operative treatment.
1. Understands mediastinal infections and their management.
2. Understands the diagnostic tests available.
3. Understands evaluation and management of myasthenia gravis
a. Relationship to thymoma
b. Laboratory testing
c. Indications for surgery
d. Perioperative management
e. Surgical techniques
4. Recognises the histologic appearance of benign and malignant mediastinal neoplasms.
5. Understands the neoplastic and non-neoplastic mediastinal diseases.
6. Understands the operative management of benign and malignant mediastinal neoplasms.
7. Understands chemotherapy and radiotherapy in mediastinal neoplasm management.
Contents:
1. Anterior mediastinal tumors
a. Thymoma
1. Histologic appearance
2. Management
b. Thyroid
1. Histologic appearance
2. Management
c. Teratoma
1. Histologic appearance
2. Management
d. Lymphoma
1. Histologic appearance
2. Management
e. Germ cell tumor
1. Histologic appearance
2. Management
2. Middle mediastinal tumors
a. Lymphoma
1. Histologic appearance
2. Management
b. Hamartoma
1. Histologic appearance
2. Management
c. Cardiac tumors
1. Histologic appearance
2. Management
3. Posterior mediastinum (paravertebral sulcus)
a. Neurilemoma
1. Histologic appearance
2. Management
b. Neurofibroma
1. Histologic appearance
2. Management
c. Pheochromocytoma
1. Histologic appearance
2. Management
d. Ganglion neuroma
1. Histologic appearance
2. Management
e. Dumbbell neurogenic tumor
1. Histologic appearance
2. Management
4. Mediastinal infection
a. Postoperative
b. Primary (Ludwig’s angina)
c. Management (operative and non-operative)
5. Diagnostic tests
a. Plain radiographs
b. CT scans
c. MRI
d. Contrast studies
e. Radionucleotide studies
f. Ultrasound
g. Fine needle aspiration
h. Core biopsy
i. Mediastinoscopy
j. Serologic tests
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to performs diagnostic tests and operations on the mediastinum under supervision.
2. Be able to diagnose and manage mediastinal infection.
3. Be able to recognise the histologic appearance of mediastinal tumors.
4. Manages patients with mediastinal tumors.
1. Understands mediastinal infections and their management.
2. Understands the diagnostic tests available.
3. Understands evaluation and management of myasthenia gravis
a. Relationship to thymoma
b. Laboratory testing
c. Indications for surgery
d. Perioperative management
e. Surgical techniques
4. Recognises the histologic appearance of benign and malignant mediastinal neoplasms.
5. Understands the neoplastic and non-neoplastic mediastinal diseases.
6. Understands the operative management of benign and malignant mediastinal neoplasms.
7. Understands chemotherapy and radiotherapy in mediastinal neoplasm management.
Contents:
1. Anterior mediastinal tumors
a. Thymoma
1. Histologic appearance
2. Management
b. Thyroid
1. Histologic appearance
2. Management
c. Teratoma
1. Histologic appearance
2. Management
d. Lymphoma
1. Histologic appearance
2. Management
e. Germ cell tumor
1. Histologic appearance
2. Management
2. Middle mediastinal tumors
a. Lymphoma
1. Histologic appearance
2. Management
b. Hamartoma
1. Histologic appearance
2. Management
c. Cardiac tumors
1. Histologic appearance
2. Management
3. Posterior mediastinum (paravertebral sulcus)
a. Neurilemoma
1. Histologic appearance
2. Management
b. Neurofibroma
1. Histologic appearance
2. Management
c. Pheochromocytoma
1. Histologic appearance
2. Management
d. Ganglion neuroma
1. Histologic appearance
2. Management
e. Dumbbell neurogenic tumor
1. Histologic appearance
2. Management
4. Mediastinal infection
a. Postoperative
b. Primary (Ludwig’s angina)
c. Management (operative and non-operative)
5. Diagnostic tests
a. Plain radiographs
b. CT scans
c. MRI
d. Contrast studies
e. Radionucleotide studies
f. Ultrasound
g. Fine needle aspiration
h. Core biopsy
i. Mediastinoscopy
j. Serologic tests
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to performs diagnostic tests and operations on the mediastinum under supervision.
2. Be able to diagnose and manage mediastinal infection.
3. Be able to recognise the histologic appearance of mediastinal tumors.
4. Manages patients with mediastinal tumors.
D. Congenital and Acquired Abnormalities of the Pericardium
Objectives:This section teaches the student; pericardial diseases and gains knowledge to perform operative and non-operative managements under supervision.
1. Understands the physiologic consequences of an enlarging increased pericardial effusion fluid and the techniques for diagnosis and management.
2. Understands the operative management of benign and malignant pericardial neoplasms.
3. Understands the physiologic consequences of pericardial constriction and the techniques for diagnosis and management.
Contents:
1. Pericardial effusions
a. Benign
b. Malignant
c. Diagnostic tests
d. Management (operative and non-operative)
2. Constrictive pericarditis
a. Infectious
b. Postoperative
c. Diagnostic tests to differentiate from restrictive disease
d.Management (operative and non-operative)
3. Pericardial cysts and tumors
a. Congenital cysts
b. Benign tumors
c. Malignant tumors
d. Management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to apply knowledge of abnormal pathophysiology to diagnose pericardial disease.
2. Be able to evaluate and manage patients with pericardial cysts or tumors under supervision.
3. Be able to performs diagnostic tests and therapeutic interventions for the treatment of pericardial tamponade, pericardial effusions, and constrictive pericardial disease independently or under supervision.
1. Understands the physiologic consequences of an enlarging increased pericardial effusion fluid and the techniques for diagnosis and management.
2. Understands the operative management of benign and malignant pericardial neoplasms.
3. Understands the physiologic consequences of pericardial constriction and the techniques for diagnosis and management.
Contents:
1. Pericardial effusions
a. Benign
b. Malignant
c. Diagnostic tests
d. Management (operative and non-operative)
2. Constrictive pericarditis
a. Infectious
b. Postoperative
c. Diagnostic tests to differentiate from restrictive disease
d.Management (operative and non-operative)
3. Pericardial cysts and tumors
a. Congenital cysts
b. Benign tumors
c. Malignant tumors
d. Management (operative and non-operative)
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Be able to apply knowledge of abnormal pathophysiology to diagnose pericardial disease.
2. Be able to evaluate and manage patients with pericardial cysts or tumors under supervision.
3. Be able to performs diagnostic tests and therapeutic interventions for the treatment of pericardial tamponade, pericardial effusions, and constrictive pericardial disease independently or under supervision.
