Superior Mediastinal Space

spatium mediastini superioris

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.

Anatomical Data

Structure & Supply

Location	Upper chest, between the thoracic inlet and a plane from the sternal angle to the T4-T5 disc
Parts	Thymus or its remnant Brachiocephalic veins and upper superior vena cava Aortic arch with brachiocephalic trunk, left common carotid and left subclavian arteries Trachea Oesophagus Thoracic duct Vagus, phrenic and left recurrent laryngeal nerves Lymph nodes
Lymphatic drainage	Brachiocephalic nodes Paratracheal and tracheobronchial nodes

Biomechanics

Function & Actions

Channel for the great vessels, airway, oesophagus and nerves passing between the neck and the chest. Masses here can compress the superior vena cava or trachea.

Clinical Relevance

Clinical Notes

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.

Pathology

Common Injuries & Conditions

Superior Vena Cava Syndrome from Superior Mediastinal Mass

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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