5 MediastinumExtends superiorly to the thoracic outlet ,root of the neck &inferiorly to the diaphragm.extends anteriorly to the sternum & posteriorly to the vertebral column.It contains :thymus, trachea, thoracic duct ,the heart esophagus, large blood vessels, lymph nodes, vagus & phrenic nerves, & sympathetic trunks.
10 The inferior mediastinum subdivided into:anterior mediastinum, a space between the pericardium and the sternumMiddle mediastinum pericardium and heartposterior mediastinum, between “pericardium &vertebral column”
12 Superior Mediastinum is bounded: front by manubrium sterni behind by first 4 thoracic vertebrae.It contains:(a) Thymus, (b) large veins, (c) large arteries, (d) trachea, (e) esophagus and thoracic duct, (f) nerves
30 2)superior hemiazygos v. 3)Inferior hemiazygos v. Azygos Venous system:consist of:2)superior hemiazygos v.azygos v.3)Inferior hemiazygos v.
31 They drain blood from:posterior intercostal spacesposterior abdominal wallpericardiumdiaphragmbronchiesophagus.
32 Azygos Vein formed by union of: SVCT5Azygos V.1)right subcostal v. 2)right ascending lumbar v.IVC
33 8 lower right posterior intercostal v. Tributaries:Superiorhemiazygos veins.RT superiorintercostal v.8 lower right posterior intercostal v.Inferiorhemiazygos veinsMediastinal veins.
34 1)Azygos Veinformed by union of the right ascending lumbar vein and the right subcostal vein. b. It ascends through aortic opening in the diaphragm on the right side of the aorta to the level of the fifth thoracic vertebra.Arch over the root of the right lung to empty into the SVCe. The azygos vein tributaries are:a. The 8 lower right posterior intercostal veins.b. The right superior intercostal vein.c. The superior and inferior hemiazygos veins.d. Mediastinal veins.
35 Inferior Hemiazygos Vein It is formed by the union of the left ascending lumbar vein & left subcostal vein.It ascends through the left crus of the diaphragm at T8.turns to the right and joins the azygos vein.It receives as tributaries some lower left intercostal veins and mediastinal veins.
36 Superior Hemiazygos Vein It is formed by the union of the 4 to the 8 intercostal veins.It joins the azygos vein at the level of the T7.
37 Mediastinum lymphLymph nodes draining the lungs, mediastinal structures empty into the :bronchomediastinal trunks & thoracic duct.
38 left Brachiocephalic v. Thoracic Ductbegins in the abdomen as a dilated sac (cisterna chyli)Asend to the root of the neck to empty into beginning of the left Brachiocephalic veincisterna chyli
39 3) broncho-mediastinal lymph trunks. At the root of the neck, the thoracic duct receives:.1)left jugular trunk2)LTSubclavian trunk3) broncho-mediastinal lymph trunks.
45 Thoracic Part of the Sympathetic Trunk 1 Thoracic Part of the Sympathetic Trunk 1. continuous above with the cervical and below with the lumbar parts of the sympathetic trunk. 2. It is the most laterally placed structure in the mediastinum. 3. It runs downward on the heads of the ribs. 4. It leaves the thorax on the side of the body of the T12 by passing behind the medial arcuate ligament.
46 5.. The sympathetic trunk has 12 (often only 11) segmentally arranged ganglia, each with white and gray ramus communicans passing to the corresponding spinal nerve. 6. The first ganglion is often fused with the inferior cervical ganglion to form the stellate ganglion.
59 Thymus1. The thymus is a flattened, bilobed structure. 2. It lies between the sternum & pericardium in the anterior mediastinum. 3. In newborn infant, it reaches its largest size so it may extend up through the superior mediastinum in front of the great vessels into the root of the neck. 4. It continues to grow until puberty but thereafter undergoes involution
60 5. It has a pink, lobulated appearance. 6. It is the site for development of T (thymic) lymphocytes.Blood SupplyThe blood supply of the thymus is from the inferior thyroid & internal thoracic arteries.
61 Large Veins of the Thorax 1. Brachiocephalic Veins:The right brachiocephalic vein is formed by union of right subclavian & right internal jugular veins.begins posterior to the sternoclavicular joint of the right clavicle, and descends almost vertically to join the left brachiocephalic vein, forming superior vena cavaIts tributariesvertebral, internal thoracic, inferior thyroid sometimes the first right posterior intercostal veins.
62 b. The left brachiocephalic vein. It is formed by the union of the left subclavian and the right internal jugular veins.begins posterior to the sternoclavicular joint of left clavicle* It passes obliquely behind the manubrium sterni and in front of the large branches of the aortic arch.* sternal end of the first right costal cartilage it joins the right brachiocephalic vein to form the superior vena cavaIts tributariesvertebral, internal thoracic, inferior thyroid, superior intercostal, sometimes the first left posterior intercostal, thymic and pericardial veins.
63 2. Superior Vena Cava:It contains all the venous blood from head and neck and both upper limbs.It is formed by the union of the two brachiocephalic veins.It passes downward to end in the right atrium of the heart.The azygos vein joins the posterior aspect of the superior vena cava just before it enters the pericardium.