The superior mediastinum lies above the sternal angle, containing the great vessels, trachea, oesophagus, thymus remnant, thoracic duct, and vagus and phrenic nerves. It is the territory of superior vena cava syndrome and anterior mediastinal tumours.
The superior mediastinal space is the target of anterior mediastinoscopy (Chamberlain procedure) for diagnosis of anterior mediastinal masses. Superior vena cava syndrome from compression in this space produces facial oedema, arm swelling, and dilated neck veins. Thymic tumours, lymphoma, and germ cell tumours occupy the anterior superior mediastinal space and are biopsied via Chamberlain approach or VATS.
Venous outflow obstruction from superior mediastinal tumour compression producing facial plethora, arm oedema, and dilated chest wall collateral veins, managed by tissue diagnosis and tumour-directed treatment.
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