Mediastinoscopy (say "mee-dee-yass-tuh-NAW-skuh-pee") is a procedure that looks at the space behind your breastbone and between your lungs. This area is called the mediastinum (say "mee-dee-ya-STY-num").
During the test, a doctor makes a small cut (incision) in the neck just above the breastbone. Sometimes the cut is made on the left side of the chest next to the breastbone. Then the doctor places a lighted tube into the cut. The tube lets the doctor look around inside that space.
This test is done to look for problems such as infection, inflammation, or cancer. The doctor may use the tube to take a sample of tissue from the area. This is called a biopsy. The sample can then be looked at under a microscope for problems.
This procedure usually takes about an hour.
Why It Is Done
This test is done to:
- Look for problems of the lungs and mediastinum, such as sarcoidosis.
- Diagnose lung cancer or lymphoma (including Hodgkin disease). It is often done to check lymph nodes to see if you should have lung removal surgery to treat lung cancer. Treatment may include surgery, radiation, or chemotherapy.
- Diagnose certain types of infection, such as tuberculosis.
How To Prepare
Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.
Preparing for the procedure
- Be sure to ask what may be done, such as lymph nodes being biopsied or removed, for each possible biopsy result.
- Your doctor may order certain blood tests, such as a complete blood count or clotting factors, before your procedure.
- Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
- Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
- Understand exactly what procedure is planned, along with the risks, benefits, and other options.
- Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
- If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your procedure. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
- Make sure your doctor and the hospital have a copy of your advance directive. If you don't have one, you may want to prepare one. It lets others know your health care wishes. It's a good thing to have before any type of surgery or procedure.
How It Is Done
Remove glasses, contact lenses, and dentures or a removable bridge just before the test. You'll be asked to take off your jewelry.
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.
After the test, you will be taken to the recovery room. You may feel sleepy for several hours.
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.
How long the test takes
The entire procedure usually takes about an hour.
How It Feels
Before the test, you may be given medicine to relax you. You will then get general anesthesia, which will make you sleep.
Problems from mediastinoscopy aren't common. But they 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.
Lymph nodes are small and smooth, and they appear normal.
There are no growths, abnormal tissue, or signs of infection.
Lymph nodes may be enlarged or appear abnormal. This may mean sarcoidosis, infection, or cancer. Tissue samples are removed and examined under the microscope.
Abnormal growths (such as a tumor) or signs of infection (such as an abscess) may be found in the chest cavity, or mediastinum.