Mediastinoscopy is a minor, minimally invasive surgery that inspects the mediastinal area — the part of the chest cavity between the breastbone and the spinal column, just between the lungs. It is used to check for enlarged lymph nodes in the chest and determine their cause.

Mediastinoscopy can be instrumental in diagnosing sarcoidosis, an inflammatory condition that affects tissues throughout the body. It is considered to be the “gold standard” for investigating lymph nodes and other structures in the mediastinal region.

How mediastinoscopy is performed

Mediastinoscopy uses a scope, sometimes with a video camera, to investigate the structures of the chest and upper airways. This small scope is inserted into the chest cavity through small incisions made in the collarbone region.

In addition to giving doctors a view of the area, the scope also takes biopsies — tissue samples — of enlarged lymph nodes and parts of the airways that can then be further tested in the laboratory.

The procedure usually takes about 60-90 minutes. Recovery time is short, and patients rarely have complications. Sutures are used to close the opening in the breastbone area where the scope was inserted. These sutures will have to be removed at a later date.

Once the mediastinoscopy is completed, chest X-rays may be taken to further investigate the affected areas.

Diagnosing sarcoidosis with mediastinoscopy

Although sarcoidosis can affect many tissues and organs, it may cause only minor symptoms. These may include fever, joint pain, and red raised bumps on the legs that may come and go on their own. Due to this, it can take months or even years before a patient is diagnosed with the disease.

The hallmark of sarcoidosis, however, is the presence of granulomas in the lungs and enlarged lymph nodes in the chest that are sometimes picked up by chance when the patient undergoes a chest X-ray for another reason.

In such cases, mediastinoscopy can be used to further investigate the airways and the lymph nodes and help confirm a diagnosis of sarcoidosis as well as rule out other conditions.

A study, published in The Journal of Thoracic and Cardiovascular Surgeryshowed that mediastinoscopy was very effective at diagnosing sarcoidosis, even when compared with more expensive surgeries and diagnostic methods such as electronic ultrasound.

Potential complications of mediastinoscopy

Mediastinoscopy is a surgery that needs to be performed while the patient is under general anesthesia. It is considered to have a low risk of complications or damage, and does not require any special precautions outside of the usual minor surgery precautions. To reduce the risk of any complications, patients are advised not to eat or drink anything for eight hours before the operation and answer a set of questions about their health and medical history.

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