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Introduction ⬇

A mediastinoscopy is a procedure that is performed to examine and biopsy mediastinal lymph nodes, stage lung tumors, diagnose sarcoidosis, biopsy and remove mediastinal lymph nodes directly, and assess hilar adenopathy of unknown origin. It has virtually replaced scalene fat pad biopsy for examining suspicious nodes on the right side of the mediastinum. It is the routine method of establishing tissue diagnosis and staging of lung cancer and for evaluating the extent of lung tumor metastasis, done just before thoracotomy. Nodes on the left side of the chest are usually resected through left anterior thoracotomy (mediastinoscopy). This procedure is performed by a thoracic surgeon under general anesthesia and requires insertion of a lighted mirror-lens instrument, similar to a bronchoscope, through an incision at the base of the anterior neck. Because these nodes receive lymphatic drainage from the lungs, mediastinal biopsy specimens can allow identification of diseases such as carcinoma, granulomatous infection, sarcoidosis, coccidioidomycosis, and histoplasmosis.

Procedure ⬆ ⬇

  1. Mediastinoscopy is considered a surgical procedure and is usually performed under general anesthesia in a hospital.

  2. Biopsy is performed through a suprasternal incision in the neck (2–3 cm or 3–4 cm). When the Chamberlain procedure is performed, a small transverse incision is done in the second intercostal space or over the second or third costal cartilage.

  3. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

  1. Abnormal findings may include the following conditions:

    1. Sarcoidosis (chronic inflammatory cell accumulation in multiple organs)

    2. Tuberculosis

    3. Histoplasmosis (disease caused by the fungus Histoplasma capsulatum)

    4. Hodgkin disease (cancer of the lymphatic system)

    5. Granulomatous infections and inflammatory processes

    6. Carcinomatous lesions

    7. Coccidioidomycosis

    8. Pneumocystis carinii infection

  2. Results assist in defining the extent of metastatic process, staging of cancer (N2 and N3, IIIA and IIIB), and possibility of successful surgical resectability.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, benefits, and risks of the test. It is usually performed after computed tomography (CT) scan has indicated enlarged mediastinal nodes (>1 cm).

  2. Ensure that a consent form is signed and in the patient’s medical record (see Chapter 1).

  3. Provide preoperative care as that for any patient undergoing general anesthesia and surgery.

  4. Confirm that the patient has fasted for 8 or more hours before the test.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

Care is the same as for any patient who has had surgery under general anesthesia.

  1. Evaluate breath and lung sounds; check wound for bleeding and hematoma.

  2. At time of discharge, monitor for complications (e.g., breathing difficulties, coughing up blood). Instruct the patient to call healthcare provider if problems occur.

  3. After endoscopic procedures, assess for fever, elevated white blood cells, signs of bloodstream infection, and signs of sepsis (rigors and hypotension, hypothermia, or hyperthermia).

  4. Review test results; report and record findings. Modify the nursing care plan as needed. Monitor patient appropriately and explain any need for follow-up tests or treatment (e.g., medication for tuberculosis, antibiotics).

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. Previous mediastinoscopy contraindicates repeat examination because adhesions make satisfactory dissection of nodes extremely difficult or impossible.

  2. Complications can result from the risks associated with general anesthesia and from preexisting conditions, pneumothorax, and subcutaneous emphysema.

  3. Damage to major vessels can occur during this procedure.

Reference Values ⬆

Normal