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The mediastinum is a complex anatomic compartment within the central thoracic cavity, bounded laterally by the lungs. This region extends from the thoracic inlet superiorly to the diaphragm inferiorly. The mediastinum contains multiple vital organs and critical anatomical structures. Knowledge of mediastinal anatomy helps narrow the differential diagnosis during evaluation of mediastinal masses and guide appropriate imaging selection. Mediastinal pathology encompasses congenital abnormalities; vascular, traumatic, and infectious conditions; and benign and malignant neoplasms. Computed tomography (CT) is generally considered the imaging modality of choice. However, magnetic resonance imaging (MRI), positron emission tomography (PET) with CT (PET-CT), and ultrasonography (US) provide complementary diagnostic information. Chest radiography remains the most common initial imaging modality for mediastinal assessment.