1. To review key anatomical features of the mediastinum, the so called “Pandora’s box” – what the radiologist needs to know. 2. To highlight the importance of different imaging modalities (conventional radiology, CT or MRI) in assessing the posterior mediastinum pathology and how to narrow down the differential diagnosis.

Although the posterior mediastinum (PM) is a relatively small anatomic region, it is home to a wide-ranging pathology, posing an interesting diagnostic challenge. According to a widely used classification, PM is located anterior to the dorsal vertebral bodies T5-T12, posterior to pericardium and diaphragm, and between the parietal pleura of the two lungs. Generally, the affected structures are neural components, the thoracic aorta, esophagus, lymph nodes and the paravertebral space [1]. The lesion’s location and relation to the surrounding structures, alongside imaging features are key...

Chest X-Ray (CXR) often represents the initial imaging examination, being important in detecting and localizing mediastinal masses when clinically suspected. Paravertebral masses disrupt the paraspinal stripes, which is helpful in localizing the lesion in the posterior compartment, but the diagnostic value of conventional radiography remains rather limited [3]. Ultimately, cross-sectional imaging (CT, MRI) plays a crucial role in distinguishing between different types of mediastinal masses and identifying their origin and cause, based on morphological characteristics related to fat, fluid, soft tissue or calcium content. The...

The radiologist must possess great knowledge of the mediastinal anatomy,establish an algorithmic radiological approach to its disease processes and use all available imaging tools to deliver a focused differential diagnosis and ultimately guide patients’ management.

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