MEDIASTINUM. MEDIASTINUM DEFINITION OF MEDIASTINUM It is a partition between the right & left pleural sacs. It includes all the structures which lie.

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Presentation transcript:

MEDIASTINUM

DEFINITION OF MEDIASTINUM It is a partition between the right & left pleural sacs. It includes all the structures which lie in the intermediate compartments of the thoracic cavity

DIVISIONS OF MEDIASTINUM

DIVISIONS OF MEDIASTINUM It is divided by a horizontal plane extending from sternal angle to lower border of 4th thoracic vertebra into: Superior mediastinum: above the plane Inferior mediastinum: below the plane, it is subdivided into: Anterior mediastinum: in front of pericardium Middle mediastinum: contains heart & pericardium Posterior mediastinum: behind pericardium

SUPERIOR MEDIASTINUM BOUNDARIES: Anterior: manubrium sterni Posterior: Upper 4 thoracic vertebrae Superior: Plane of thoracic inlet Inferior: Horizontal plane On each side: Pleura

SUPERIOR MEDIASTINUM

SUPERIOR MEDIASTINUM

SUPERIOR MEDIASTINUM

SUPERIOR MEDIASTINUM CONTENTS: FROM BEHIND FORWARD: Esophagus Trachea Arch of aorta & its 3 branches: brachiocephalic, left common carotid & left subclavian arteries Right & left brachiocephalic veins & superior vena cava Thymus gland

SUPERIOR MEDIASTINUM OTHER CONTENTS: Nerves: Right & left vagus Right & left phrenic Right & left sympathetic trunks Left recurrent laryngeal Lymphatic structures: Thoracic duct Lymph nodes

POSTERIOR MEDIASTINUM BOUNDARIES: Anterior: Pericardium & diaphragm Posterior: Lower 8 thoracic vertebrae Superior: Horizontal plane Inferior: Diaphragm On each side: Pleura

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM CONTENTS: Esophagus (most anterior structure) Thoracic duct Right & left vagus Descending aorta Azygos & hemiazygos veins Right & left sympathetic trunks & their branches (splanchnic nerves) Lymph nodes

MIDDLE MEDIASTINUM CONTENTS: Pericardium & heart Arteries: ascending aorta, pulmonary trunk Veins: lower half of superior vena cava, terminations of inferior vena cava & pulmonary veins Nerves: phrenic Lymph nodes

MEDIASTINUM

VEINS BRACHIOCEPHALIC: (Superior mediastinum) FORMATION: by union of internal jugular & subclavian vein (behind medial end of clavicle) END: Both veins unite to form S.V.C. RIGHT VEIN: shorter & has a vertical course, related laterally to right phrenic nerve & right pleura & lung, its tributaries in thorax: right 1st posterior intercostal vein, right internal thoracic vein, right lymphatic duct LEFT VEIN: longer & has an oblique course, related anteriorly to manubrium & thymus gland, & posteriorly to branches of arch of aorta, its tributaries in thorax: left 1st posterior intercostal vein, left superior intercostal vein, left internal thoracic vein, thoracic duct

VEINS SUPERIOR VENA CAVA: (Superior & middle mediastinum) FORMATION: by union of brachiocephalic veins, behind lower border of right 1st costal cartilage END: opens into right atrium behind right 3rd costal cartilage TRIBUTARIES: azygos vein

AZYGOS & HEMIAZYGOS VEINS

VEINS AZYGOS VEIN: (Posterior mediastinum) ORIGIN: by union of right ascending lumbar & subcostal veins (passes through aortic opening of diaphragm) END: forms an arch above the root of right lung & ends in S.V.C. opposite lower border of T4 RELATIONS: Anterior: esophagus Posterior: thoracic vertebra Right: right pleura & lung Left: thoracic duct TRIBUTARIES: superior & inferior hemiazygos veins, right superior intercostal vein, right posterior intercostal veins (from 4th to 11th), right bronchial veins, esophageal & pericardial veins

INFERIOR HEMIAZYGOS: (Posterior mediastinum) VEINS INFERIOR HEMIAZYGOS: (Posterior mediastinum) ORIGIN: by union of left ascending lumbar & subcostal veins (passes through left crus of diaphragm) END: into azygos vein, opposite T8 TRIBUTARIES: left posterior intercostal veins (9th to 11th), esophageal veins

VEINS SUPERIOR HEMIAZYGOS: (Posterior mediastinum) ORIGIN: by left posterior intercostal veins (4th to 8th) END: into azygos vein, opposite T7 TRIBUTARIES: left bronchial veins INFERIOR VENA CAVA: (Posterior mediastinum) END: passes through vena caval opening of diaphragm & opens into right atrium behind right 6th costal cartilage

ARTERIES AORTA: ASCENDING AORTA: (Middle mediastinum) ORIGIN: at the base of left ventricle opposite lower border of left 3rd costal cartilage END: ascends upward, forward & to the right & continues as arch of aorta BRANCHES: right & left coronary arteries

ARTERIES ARCH OF AORTA: (Superior mediastinum) ORIGIN: continuation of ascending aorta, opposite upper border of right 2nd costal cartilage COURSE & RELATIONS: ascends upward backward & to the left (behind manubrium & in front of trachea) then curves backward (to the left of trachea) then finally curves downward TERMINATION: continues as descending aorta, opposite lower border of T4

ARTERIES BRANCHES OF ARCH OF AORTA: (Superior mediastinum) BRACHIOCEPHALIC: ascends upward & to the right (behind left brachiocephalic vein & in front of trachea) & divides into right common carotid & right subclavian arteries (behind right sternoclavicular joint) LEFT COMMON CAROTID: ascends upward & to the left (to the left side of brachiocephalic artery) & enters the neck (behind left sternoclavicular joint) LEFT SUBCLAVIAN: ascends upward (behind left common carotid artery, in front of esophagus, to the left side of trachea), arches over apex of left lung to enter neck

ARTERIES DESCENDING AORTA: (Posterior mediastinum) ORIGIN: continuation of arch of aorta TERMINATION: passes through aortic opening of diaphragm (opposite T12) & continues as abdominal aorta RELATIONS: Anterior: esophagus Posterior: thoracic vertebrae Right: thoracic duct Left: left pleura & lung BRANCHES: posterior intercostal (from 3rd to 11th), subcostal, bronchial, esophageal, pericardial arteries

ARTERIES PULMONARY TRUNK (Middle mediastinum) ORIGIN: from upper part of right ventricle, behind sternal end of left 3rd costal cartilage COURSE: ascends upward & to the left & divides (at lower border of T4) into: Right pulmonary: runs behind ascending aorta & S.V.C to enter root of right lung Left pulmonary: runs in front of desending aorta to enter root of left lung

TRACHEA BEGINNING: continuation of larynx, opposite C6 TERMINATION: bifurcates into 2 bronchi, opposite lower border of T4 RELATIONS: (in superior mediastinum) Anterior: arch of aorta, brachiocephalic & left common carotid arteries Posterior: left recurrent laryngeal nerve, esophagus Right: right vagus nerve Left: arch of aorta, left subclavian artery NERVE SUPPLY: sympathetic trunks & vagus BLOOD SUPPLY: inferior thyroid vessels LYMPHATIC DRAINAGE: pretracheal & paratracheal

ESOPHAGUS BEGINNING: continuation of pharynx, opposite C6 TERMINATION: passes through esophageal opening of diaphragm (opposite T10) & joins stomach RELATIONS: (in superior mediastinum) Anterior: left recurrent laryngeal nerve, trachea, left subclavian artery Posterior: thoracic vertebrae Right: right pleura & lung Left: thoracic duct, left pleura & lung

ESOPHAGUS RELATIONS: (in posterior mediastinum) Anterior: pericardium, separating it from left atrium Posterior: thoracic duct, descending aorta, azygos vein Right: right pleura & lung Left: descending aorta, left pleura & lung NERVE SUPPLY: as trachea ARTERIAL SUPPLY: descending aorta VENOUS DRAINAGE: azygos & hemiazygos LYMPHATIC DRAINAGE: posterior mediastinal lymph nodes

THORACIC DUCT ORIGIN: from upper end of cysterna chyli (opposite L1 & L2) COURSE: passes through aortic opening of diaphragm, ascends in posterior mediastinum (behind esophagus) & in superior mediastinum (to the left of esophagus) to enter root of neck END: in left brachiocephalic vein RELATIONS: ( in posterior mediastinum) Anterior: esophagus Posterior: thoracic vertebrae Right: azygos vein Left: descending aorta

THORACIC DUCT TRIBUTARIES: It drains lymph from both sides of the body below the diaphragm through cysterna chyli It drains lymph from left half of the body above diaphragm through: Left jugular lymph trunk: drains left side of head & neck Left subclavian lymph trunk: drains left upper limb Left bronchomediastinal lymph trunk: drains left side of thorax

RIGHT LYMPHATIC DUCT ORIGIN: formed by union of: Right jugular lymph trunk: drains right side of head & neck Right subclavian lymph trunk: drains right upper limb Right bronchomediastinal lymph trunk: drains right side of thorax END: in right brachiocephalic vein

NERVES PHRENIC NERVES: (Superior & middle mediastinum) ORIGIN: anterior rami of C3,4,5 COURSE & RELATIONS IN THORAX: RIGHT: descends to the right side of: right brachiocephalic vein, S.V.C., pericardium, I.V.C. LEFT: descends to the left side of: arch aorta, pericardium BRANCHES: Motor branches to: diaphragm Sensory branches from: Mediastinal & central part of diaphragmatic pleura Fibrous pericardium & parietal layer of serous pericardium Peritoneum covering central part of undersurface of diaphragm

NERVES VAGUS NERVES: (Superior & posterior mediastinum) ORIGIN: 10th cranial nerve COURSE & RELATIONS IN THORAX: RIGHT: descends to the right side of: trachea, behind root of right lung (pulmonary plexus), behind esophagus (esophageal plexus), passes through esophageal opening of diaphragm to reach posterior surface of stomach LEFT: descends to the left side of: arch aorta, behind root of left lung (pulmonary plexus), in front of esophagus (esophageal plexus), passes through esophageal opening of diaphragm to reach anterior surface of stomach

NERVES BRANCHES IN THORAX: BOTH VAGI: to lungs & esophagus RIGHT VAGUS: to heart LEFT VAGUS: left recurrent laryngeal nerve: curves below arch of aorta, behind ligamentum arteriosum, ascends in groove between trachea & esophagus to reach the neck. It supplies: heart, trachea, esophagus (in thorax) & larynx (in neck)

NERVES THORACIC PART OF SYMPATHETIC TRUNKS: (Superior & posterior mediastinum) BEGINNING: the cervical part continues as thoracic part by passing in front of neck of first rib TERMINATION: the thoracic part continues as lumbar part by passing behind medial arcuate ligament COURSE: In upper part of thorax: descend in front of heads of ribs In lower part of thorax: descend on the sides of bodies of vertebrae GANGLIA: usually 11 (1st thoracic ganglion fuses with inferior cervical ganglion forming stellate ganglion)

NERVES BRANCHES: Rami communicantes: each ganglion receives a white ramus (preganglionic) & gives a grey ramus (postganglionic) to corresponding thoracic spinal nerve Visceral branches (postganglionic) to thoracic organs (from upper 5 ganglia): to heart, lungs, esophagus, descending aorta Visceral branches (preganglionic) to abdominal organs: Greater splanchnic nerve (from 5th to 9th ganglia) Lesser splanchnic nerve (from 10th 7 11th ganglia) Lowest splanchnic nerve (from 12th ganglion)