Key Points

• The anatomy of the mediastinum is presented in four compartments. Allocation of a mass to predominantly one compartment influences the clinician in developing a differential diagnosis.
• Limited surgical access procedures have been devised to obtain diagnostic tissue samples from each of the four mediastinal compartments. Occasionally, complete surgical resections can be performed using these limited access procedures.

This chapter describes the anatomy of the mediastinum with emphasis on issues of practical importance for the surgeon. It discusses the compartments of the mediastinum, as derived from clinical experience, which serve as a framework from which the clinician can develop a differential diagnosis for a given mediastinal mass. It also discusses various limited surgical approaches by which a surgeon can obtain access to the mediastinum, either to obtain diagnostic material or to drain potential mediastinal spaces.