Mediastinoscopy
Test OverviewMediastinoscopy is surgery to look at the inside of
the upper chest between and in front of the lungs. This area is called the mediastinum.
During the test, a doctor makes a small cut (incision) in the neck just above
the breastbone or on the left side of the chest next to the breastbone. Then the doctor places a
thin scope in the opening. A tissue sample
(biopsy) can be collected through the scope
and then looked at under a microscope for lung problems. These problems might include infection,
inflammation, or cancer. In many cases, this surgery has been replaced by other biopsy methods that use
computed tomography (CT),
endoscopic ultrasound, or
bronchoscopy to guide a biopsy needle. This test may still be needed when the other methods can't be used
or when they don't show clear results. Why It Is DoneThis test is done to: - Look for problems of the lungs and mediastinum,
such as
sarcoidosis.
- Diagnose
lung cancer or
lymphoma (including
Hodgkin's disease). It is often done to
check lymph nodes to see if you should have lung removal surgery to
treat lung cancer. The test can also help your doctor recommend the best
treatment for lung cancer. Treatment may include surgery,
radiation, or
chemotherapy.
- Diagnose
certain types of infection, such as
tuberculosis.
How To PrepareYou will be asked to sign a consent
form that says you understand the risks of the test and agree to have it done. Talk to your doctor if you have any concerns about the need for the test, its risks, how it will be done, or what the
results will mean. Be sure to ask what may be done
after 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 this test,
tell your doctor if you: - Are taking any medicines.
- Have
allergies to any medicines, including
anesthetics.
- Take a blood thinner, or if you have had bleeding problems.
- Are or might be pregnant.
Also, certain conditions may make it harder to do this test. Let your doctor know if you have: - Had this test or open-heart surgery in
the past. The scarring from the first procedure may make it hard to do a
second one.
- A history of neck problems or a neck injury,
especially anything that may have caused your neck muscles to stretch too much, like whiplash.
- Any problems in
your chest, including those you've had since birth.
- Had radiation treatment to the neck or
chest.
You will get
general anesthesia and be asleep during the
test. To prepare for this test: - Your doctor will tell you how soon to stop eating and drinking before the test. The surgery may be canceled if you don't follow these instructions. If your doctor has told you to take your medicines on the day of surgery, take them with only a sip of water.
- Leave your jewelry at home. Any jewelry you wear will
need to be removed before the test.
- Remove glasses, contact
lenses, and dentures or a removable bridge just before the test. These
will be given back to you as soon as you wake up after the test.
- Arrange to have someone drive you home if you don't need to stay in the hospital.
Your doctor may order certain blood tests, such as a
complete blood count or clotting factors, before your test. How It Is DoneMediastinoscopy is done by a
chest (thoracic) surgeon. Before the surgery, 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 to help you breathe. The doctor will make an incision just above your breastbone
at the base of your neck or on the left side of your chest near the breastbone. The scope will be inserted through the
opening. Your doctor will look at the space in your chest between your lungs
and heart.
Lymph nodes or abnormal tissue will be collected for
testing. After the scope is taken out, the incision will be
closed with a few stitches and covered with a bandage. The entire
procedure usually takes about an hour. After the test, you will be taken
to the recovery room. Some people may go home if they can swallow fluids without
gagging or choking. Others may need to stay in the hospital for 1 or 2
days. If your stitches are not the dissolving type, you will need to go back to
the doctor in 10 to 14 days to have them removed. Mediastinoscopy usually
leaves only a tiny scar. How It FeelsBefore the test, you may be given
medicine to relax you. You will then get general
anesthesia, which will make you sleep. After
you wake up, you may feel sleepy for several hours. You may feel tired for a day or two and have some general aches and pains. You may also
have a mild sore throat from the tube that was in your throat.
Using throat lozenges and gargling with warm salt water may help. RisksProblems from mediastinoscopy are uncommon
but may include bleeding, infection, a collapsed lung,
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 test, contact your doctor right away if you have: - Bleeding from your stitches.
- A
fever.
- Severe chest pain.
- Swelling in the
neck.
- Shortness of breath.
- Trouble
swallowing.
- Hoarseness of your voice that lasts more than a few
days or keeps getting worse.
ResultsMediastinoscopy is surgery to look at the inside of
the upper chest between and in front of the lungs. This area is called the mediastinum. MediastinoscopyNormal: | Lymph nodes are
small, smooth, and appear normal. |
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There are no abnormal tissue, growths, or signs of
infection. | Abnormal: | Lymph nodes may be enlarged or appear
abnormal. This may mean
sarcoidosis, infection, or cancer. Tissue samples are
removed and examined under the microscope. |
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Abnormal growths (such as a tumor) or signs
of infection (such as an
abscess) may be found in the chest cavity, or
mediastinum. | What Affects the TestIf you have had mediastinoscopy
or open-heart surgery, you may not be able to have this test. Scarring
from the first procedure may make it hard to do this test. What To Think AboutIf a lymph node
biopsy needs to be examined quickly (while you are
still asleep), the sample will be taken to the lab right away. If the lymph nodes show that you have cancer, surgery may be done
to remove the cancer while you are still asleep. If the results are not needed quickly, they will usually be ready in 2 to 4 working days. ReferencesOther Works Consulted- Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
- Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
- Pagana KD, Pagana TJ (2014). Mosby's Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.
CreditsByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerDavid C. Stuesse, MD - Cardiac and Thoracic Surgery Current as ofMarch 25, 2017 Current as of:
March 25, 2017 Last modified on: 8 September 2017
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