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Mediastinoscopy is a surgical procedure to examine the inside of
the upper chest between and in front of the lungs (mediastinum).
During a mediastinoscopy, a small cut (incision) is made in the neck just above
the breastbone or on the left side of the chest next to the breastbone. Then a
thin scope (mediastinoscope) is inserted through the opening. A tissue sample
(biopsy) can be collected through the mediastinoscope
and then examined under a microscope for lung problems, such as infection,
inflammation, or cancer. See a picture of
In many cases
mediastinoscopy has been replaced by other biopsy methods that use
computed tomography (CT),
bronchoscopy to guide a biopsy needle to the abnormal
tissue. Mediastinoscopy may still be needed when these methods can't be used
or when they don't provide conclusive results.
Mediastinoscopy is done to:
You will be asked to sign a consent
form before mediastinoscopy. Talk to your doctor about any concerns you have
regarding the need for the test, its risks, how it will be done, or what the
results will mean. Be sure to discuss with your doctor what may be done
following each possible biopsy result. If a lymph node contains cancer, surgery
may be done to remove the cancer while you are still asleep. To help you
understand the importance of this procedure, fill out the
medical test information form(What is a PDF document?).
Before you have a mediastinoscopy,
tell your doctor if you:
Also, certain conditions may make it more difficult to do a
mediastinoscopy. Let your doctor know if you have:
You will receive
general anesthesia and be asleep during the
mediastinoscopy. To prepare for your procedure:
Your doctor may order certain blood tests, such as a
complete blood count or clotting factors, before your procedure.
Mediastinoscopy is done by a
chest (thoracic) surgeon and surgical
Before the procedure, an
intravenous (IV) line will be placed in a vein to give
you fluids and medicines. After you are asleep, a tube will be placed in your
throat (endotracheal or ET tube) to help you breathe during the procedure. Your
neck and chest will be washed with an antiseptic soap and covered with a
An incision will be made just above your breastbone
at the base of your neck or on the left side of your chest near the breastbone
between the 4th and 5th ribs. The mediastinoscope will be inserted through the
opening. Your doctor will examine the space in your chest between your lungs
Lymph nodes or abnormal tissue will be collected for
examination. After the scope is removed from your chest, the incision will be
closed with a few stitches and covered with a bandage.
procedure usually takes about an hour. After the procedure, you will be taken
to the recovery room.
Some people may go home after the procedure
if the general anesthesia wears off and they are able to swallow fluids without
gagging or choking. Other people may need to stay in the hospital for 1 or 2
days. If your stitches are not the dissolving type, you will need to return to
your doctor in 10 to 14 days to have them removed. Mediastinoscopy usually
leaves only a tiny scar.
Before the procedure, you may be given
medicine that will make you sleepy and relaxed. You will receive general
anesthesia during the mediastinoscopy, which will cause you to be asleep. After
you wake up, you may feel sleepy for several hours. You may feel tired for 1 to
2 days after the procedure and have some general aches and pains. You may also
have a mild sore throat from the tube in your throat during the procedure.
Using throat lozenges and gargling with warm salt water may help relieve your
Complications from mediastinoscopy are uncommon
but may include bleeding, infection, a collapsed lung (pneumothorax),
a tear in the
esophagus, damage to a blood vessel, or injury to a
nerve near the voice box (larynx) which may cause permanent hoarseness.
After the procedure, contact your doctor immediately if you have:
Mediastinoscopy is a surgical procedure
to examine the inside of the chest between and in front of the lungs
Lymph nodes are
small, smooth, and appear normal.
No abnormal tissue, growths, or signs of
infection are present.
Lymph nodes may be enlarged or appear
abnormal, which may mean
sarcoidosis, infection, or cancer. Tissue samples are
removed and examined under the microscope.
Abnormal growths (such as a tumor) or signs
of infection (such as an
abscess) may be found in the chest cavity, or
If you have had mediastinoscopy
or open-heart surgery, you may not be able to have this procedure. Scarring
from the first procedure may make it hard to do a second procedure.
If a lymph node
biopsy needs to be examined quickly (while you are
still asleep), the sample will be taken immediately to the laboratory. There it
will be frozen and sliced into very thin sections for examination under a
microscope. If the lymph nodes show that you have cancer, surgery may be done
right away to remove the cancer while you are still asleep. If a frozen section
sample is not needed, a permanent section is made and the results usually are
available in 2 to 4 working days.
Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis:
Fischbach FT, Dunning MB III, eds. (2009).
Manual of Laboratory and Diagnostic Tests, 8th ed.
Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby.
November 1, 2012
Adam Husney, MD - Family Medicine & Robert L. Cowie, MB, FCP(SA), MD, MSc, MFOM - Pulmonology
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