The Mediastinal Visceral Space: The Central Pathway for the Spread of Mediastinal Disease.

The connective tissue of the mediastinal visceral space extends from the neck through the chest and into the abdomen. This connective tissue encases the esophagus and tracheobronchial tree and is bounded by the perivisceral fascia. The continuous longitudinal and axial interconnection of the mediastinal visceral space accounts for commonly observed bidirectional pathways of disease through the chest. Disease patterns that seem counterintuitive when viewed through the lens of gross anatomy are more understandable in view of this knowledge. This article illustrates case examples of the spread of gas, fluid, fat and soft tissue mass through the mediastinal visceral space.