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It is a very common approach for operations on the lung or posterior mediastinum, including the esophagus.
The posterior mediastinum is an irregular triangular space running parallel with the vertebral column.
The inferior mediastinum is further divided into the anterior, middle, and posterior mediastinum.
Because serious infections of teeth can spread down this space into the posterior mediastinum, it is often confused with the danger space.
The mediastinal branches are numerous small vessels which supply the lymph glands and loose areolar tissue in the posterior mediastinum.
Posterior mediastinum: Neurogenic tumors, either from the nerve sheath (mostly benign) or elsewhence (mostly malignant).
The mediastinum has three main parts: the anterior mediastinum (front), the middle mediastinum, and the posterior mediastinum (back).
The esophagus passes through posterior mediastinum in thorax and enters abdomen through a hole in the diaphragm at the level of the tenth thoracic vertebrae (T10).
The most common mediastinal masses are neurogenic tumors (20% of mediastinal tumors), usually found in the posterior mediastinum, followed by thymoma (15-20%) located in the anterior mediastinum.
It traverses the diaphragm at the aortic aperture and ascends the superior and posterior mediastinum between the descending thoracic aorta (to its left) and the azygos vein (to its right).
The contents of posterior mediastinum can be remembered using the mnemonic, "DATES", for Descending aorta, Azygous vein and hemiazygos vein, Thoracic duct, Esophagus, Sympathetic trunk/ganglia.
It is formed by the union of the ascending lumbar veins with the right subcostal veins at the level of the 12th thoracic vertebra, ascending in the posterior mediastinum, and arching over the right main bronchus posteriorly at the root of the right lung to join the superior vena cava.