313 Ch 312. Disorders of the Mediastinum, Diaphragm, and Chest Wall

Mediastinum 分 anterior + middle + posterior 三大區域，各有特定 mass DDx：anterior (“4 Ts” = thymoma, teratoma/germ cell, thyroid, terrible lymphoma)；middle (lymphadenopathy from infection/sarcoid/malignancy, bronchogenic cyst, aortic aneurysm)；posterior (neurogenic tumors — schwannoma, neuroblastoma, ganglioneuroma)；mediastinitis 分 acute (post-cardiac surgery, esophageal rupture — high mortality) 與 chronic (fibrosing — histoplasmosis, IgG4, idiopathic)；pneumomediastinum 多由 alveolar rupture (Macklin effect, asthma exacerbation, mechanical ventilation, vomiting/Boerhaave)；diaphragm disorders：paralysis (unilateral, bilateral — phrenic nerve injury)、hernias (Bochdalek, Morgagni)、eventration、hiccups；chest wall disorders：pectus excavatum / carinatum、kyphoscoliosis、ankylosing spondylitis、neuromuscular weakness (ALS, GBS, MG, muscular dystrophy)；obesity hypoventilation syndrome (OHS) + CCHS (congenital central hypoventilation syndrome) 為 ventilatory control disorders；治療多元：手術切除 mass、抗生素、NIV for respiratory failure、plication for diaphragm paralysis、Nuss procedure for pectus excavatum。