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Objective: The aim of this study is to evaluate the value of mediastinoscopy in the diagnosis of mediastinal lesions. Materials and methods: This is a prospective study. 33 patients suffering from manifestations of mediastinal lesions and appearance of shadow(s) on a chest radiograph, were included in our study. They include 16 males and 17 females. They were picked up from Al-Hussein University Hospital, Bab-Elshaaria University Hospital, and AL-Zahraa University Hospital in the period from 2009 to 2013. Their ages range between 24 years and up to 67 years. Results: In 30 out of 33 cases (90.9%), cervical mediastinoscopy provided a confirmatory final diagnosis. Three cases had minor complications in the form of, wound infections in 2 cases, and one post-procedure severe pain controlled by narcotics, and no major complications. Conclusion: Cervical mediastinoscopy is a safe, accurate and cost effective procedure minimizing hospital stay and allowing appropriate treatment to be immediately commenced upon diagnosis. Mediastinoscopy is still the best diagnostic investigation of choice for paratracheal and retrovascular mediastinal pathology.