Benign Mediasten Hastalıkları
Özet
Her iki plevral boşluk arasında yer alan mediastenin anatomik kompartmanları, enfektif hastalıkları ve benign lezyonları klinikte büyük önem taşımaktadır. Anatomik sınıflandırmada cerrahide yaygın olarak Shields'ın 3 kompartman modeli (ön, viseral, arka) tercih edilirken, literatürde 4 kompartmanlı modeller ve BT bazlı modern ITMIG sınıflaması da kullanılmaktadır. Yüksek mortalite oranına sahip olan mediastinit, kardiyotorasik cerrahi, özofagus rüptürü veya orofarengeal enfeksiyonlar sonrası akut olarak gelişebileceği gibi, tüberküloz veya sarkoidoz gibi nedenlerle kronik fibröz yapıda da görülebilir. Akut mediastinit durumlarında agresif cerrahi drenaj ve geniş spektrumlu parenteral antibiyotik tedavisi hayati önem taşır. Ön mediastende intratorasik guatr, paratiroid adenomları, timik hiperplazi, timik kistler ve benign teratomlar sık görülürken; orta mediastende perikardiyal ve bronkojenik kistler ile lipomlar; arka mediastende ise schwannoma ve nörofibroma gibi nörojenik tümörler ile özofagial kistler öne çıkmaktadır. Genellikle asemptomatik seyreden bu benign lezyonların tedavisinde cerrahi eksizyon (özellikle VATS yaklaşımı) hem kesin tanı hem de küratif tedavi sağlar. Küratif tedavi sonrasında hastaların prognozu son derece yüz güldürücüdür.
The anatomical compartments, infectious diseases, and benign lesions of the mediastinum, located between both pleural cavities, hold significant clinical importance. In surgical practice, Shields' 3-compartment model (anterior, visceral, posterior) is commonly preferred for anatomical classification, although 4-compartment models and the modern CT-based ITMIG classification are also utilized. Mediastinitis, a condition with high mortality rates, can manifest acutely following cardiothoracic surgery, esophageal rupture, or oropharyngeal infections, or it can develop chronically as fibrosing mediastinitis due to tuberculosis or sarcoidosis. Aggressive surgical drainage combined with broad-spectrum parenteral antibiotics is vital in managing acute mediastinitis. Regarding benign lesions, intrathoracic goiter, parathyroid adenomas, thymic hyperplasia, thymic cysts, and benign teratomas are frequently encountered in the anterior mediastinum. The middle mediastinum predominantly hosts pericardial and bronchogenic cysts alongside lipomas, while neurogenic tumors like schwannomas and neurofibromas, along with esophageal cysts, are typically located in the posterior compartment. Although these benign lesions often remain asymptomatic, surgical excision—particularly via video-assisted thoracoscopic surgery (VATS)—provides both definitive diagnosis and curative treatment, leading to an excellent long-term prognosis for patients.
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