(Latin mediastinum mediastinum; a syndrome) — a combination of symptoms of a prelum of vessels, nerves and bodies of a mediastinum.
MEDIONEKROZ of 525
Fig. Outward of the patient at a mediastinal syndrome with a prelum of an upper vena cava:
puffiness of the person, a thickening of a neck are visible protrusion myag ky fabrics in the field of supraclavicular poles.
In a wedge, the practician M. of page it is most often observed at injuries of a breast. Bodies of a mediastinum can be squeezed by the air, blood, pus, the edematous or sclerosed fatty tissue increased limf, nodes, an aortic aneurysm, a cyst, a tumor. Patients complain of difficulty of breath. Many note a thickening of a neck (see Stokes a collar), feeling of weight and a stethalgia or to back, headaches. At a prelum of a gullet there is a dysphagy (see), at a prelum of a recurrent guttural nerve — hoarseness of a voice. During survey sometimes reveal asymmetry of a thorax; in cases of a prelum of an upper vena cava — protrusion of cellulose in the field of supraclavicular poles, cyanosis and puffiness of the person, neck, hands and an upper part of a breast, expansion of hypodermic venous network (fig). Sometimes there are punctulate hemorrhages in a conjunctiva. Cyanosis sharply amplifies at an inclination of a trunk down. The prelum of a sympathetic trunk is followed by emergence of a syndrome of Bernard — Horner (see Bernard — Horner a syndrome). Quite often note tachycardia or bradycardia, disturbance of a cordial rhythm. At a laringoskopiya (see) sometimes reveal an immovability of one or both phonatory bands, paresis or paralysis of a throat. Venous pressure sharply increases in vessels of upper extremities (by 2 — 3 times).
In M.'s diagnosis by the village is important rentgenol. a research — roentgenoscopy, a X-ray analysis, a tomography, and according to special indications — an ezofagografiya, upper-vografiya (see), an aortografiya (see). A high-informative method is the computer tomography (see the Tomography computer). With the diagnostic purpose use also a puncture of a mediastinum and an aspiration biopsy (see), to-ruyu if necessary make under local anesthesia a fine needle in conditions rentgenol. control. Also the trakheobronkhoskopiya has a certain diagnostic value (see Bronkhoskopiya), however at patients with M. with page and high pressure in system of an upper vena cava various punctures and biopsies via the bronchoscope can be complicated by trudnoostanavli-vayemy venous bleeding.
Lech. actions at M. of page whenever possible shall be radical. Operational methods — sewing up of a wound of a trachea or bronchial tube, a final stop of bleeding, drainage of abscess, a resection of an aortic aneurysm, removal increased lifm are most effective. nodes, hematoma, cyst or tumor. At inflammatory (nonspecific and specific) processes in a mediastinum appoint antibacterial therapy, apply corticosteroid hormones and proteolytic enzymes. At patients with a lymphogranulomatosis and malignant tumors, to-rye it is impossible to remove in the operational way, apply radiation therapy and chemotherapy. Palliative actions at M. of page are all measures of a decompression, to-rye facilitate activity of respiratory and cardiovascular systems: a cervical mediastinotomy (see), aspiration of contents of abscess or cyst (see. Aspiration drainage), a partial oncotomy, imposing of bypass vascular shunts between system of an upper vena cava and the right auricle or systems top and bottom venas cava (see Shunting of blood vessels), purpose of diuretic pharmaceuticals.
See also Mediastinum.
Bibliography: Vishnevsky A. A.
, etc. Fibrous mediayetinit also a syndrome of an upper vena cava, Grudn. hir., No. 3, page 66, 1979; Ovnatanyan K. T. and Kravets V. M. Tumors and cysts of a mediastinum, Kiev, 1971; Petrovsky B. V. Hirurgiya of a mediastinum, M., 1960. „M. I. Perelman.