1-The Mediastinum extends Posteriorly: to the vertebral column

1-The Mediastinum extends Posteriorly: to the vertebral column

1-The Mediastinum extends Posteriorly: to the vertebral column Superiorly: to the thoracic outlet and the root of the neck Inferiorly: to the diaphragm Anteriorly: to the sternum An imaginary plane passing from the sternal angle anteriorly to

the lower border of the body of the fourth thoracic vertebra posteriorly divides the mediastinum into: SUPERIOR AND INFERIOR MEDIASTINA h hic W e on r?

e arg l is THE INFERIOR MEDIASTINUM is further subdivided into: 1-THE MIDDLE MEDIASTINUM consists of the pericardium and heart 2-THE ANTERIOR MEDIASTINUM is a space between the pericardium and the sternum 3-THE POSTERIOR MEDIASTINUM lies between THE PERICARDIUM And

THE VERTEBRAL COLUMN THE SUPERIOR MEDIASTINUM contains From anterior to posterior is bounded in front by the manubrium sterni and behind by the first four thoracic vertebrae posterior (a) THYMUS (b) LARGE VEINS? (c) LARGE

ARTERIES? (d) TRACHEA (e) ESOPHAGUS (f) THORACIC DUCT (g) SYMPATHETIC TRUNKS anterior Main contents! THE SUPERIOR MEDIASTINUM (a) THYMUS (b) LARGE VEINS, right and left brachiocephalic

veins and the upper half of superior vena cava. (c) LARGE ARTERIES, arch of the aorta with its three large branches. (d) TRACHEA (e) ESOPHAGUS (f) THORACIC DUCT (g) phrenic nerves, vagus nerves and SYMPATHETIC TRUNKS Anterior

Posterior Cross-section through the superior mediastinum at the level of vertebra TIII. Structures in the superior mediastinum THYMUS Involved in the early development of the immune system, the thymus is a large structure in the child, begins to atrophy after puberty In the elderly adult, it is barely identifiable as an organ, consisting mostly of fatty tissue

Large Veins of the Thorax 1-Brachiocephalic Veins A-The right brachiocephalic vein: formed by the union of the right subclavian and the right internal jugular veins (note: it is shorter and vertical) the right subclavian the right internal jugular veins

Is formed by the union of the LEFT subclavian and the LEFT internal jugular veins ( note: It passes obliquely and it is longer) It joins the right brachiocephalic vein to form the superior vena cava B-The left brachiocephalic vein: Superior Vena Cava The superior vena cava contains all the venous blood from the head and neck and both upper

limbs is formed by the union of the two brachiocephalic veins It passes downward to end in the right atrium of the heart The vena azygos joins the superior vena cava just before it enters the pericardium Azygos Veins The azygos veins consist of:

c-THE SUPERIOR HEMIAZYGOS VEIN a-THE MAIN AZYGOS VEIN b-THE INFERIOR HEMIAZYGOS VEIN Inferior Vena Cava The inferior vena cava pierces the central tendon of the diaphragm opposite the eighth thoracic vertebra and almost immediately enters the lowest part of the right atrium Large Arteries of the Thorax Aorta The aorta is the main arterial trunk that delivers oxygenated blood from the left

ventricle of the heart to the tissues of the body. It is divided for purposes of description into the following parts: A-ASCENDING AORTA B-ARCH OF THE AORTA C-DESCENDING: THORACIC AORTA (above diaphragm) ABDOMINAL AORTA (below diaphragm) A-Ascending Aorta The ascending aorta lies within the fibrous pericardium (what does this mean?) Begins at the base of the left ventricle

Ends at the level of the sternal angle, where it becomes continuous with the arch of the aorta At its root it possesses three bulges, the sinuses of the aorta Branches The right coronary artery The left coronary artery B-Arch of the Aorta is a continuation of the ascending aorta (what does this mean?) Ends at the level of the sternal angle where it becomes continuous with the descending aorta.

Branches a-THE BRACHIOCEPHALIC ARTERY arises from the convex surface of the aortic arch It divides into: 1-THE RIGHT SUBCLAVIAN ARTERY 2-RIGHT COMMON CAROTID ARTERY b-The left common carotid artery Arises from the convex surface of the aortic arch enters the neck behind the left sternoclavicular joint.

c-The left subclavian artery Why we call it subclavian? arises from the aortic arch Runs in a groove in the first rib C- Descending Thoracic Aorta lies in the posterior mediastinum begins as a continuation of the arch of the aorta (opposite the sternal angle). At the level of the 12th thoracic vertebra, it passes behind the diaphragm (through the aortic

opening) in the midline and becomes continuous with the abdominal aorta. Branches 1-Posterior intercostal arteriesAD RE are given off to the lower nine intercostal spaces 2-Pericardial, esophageal, and bronchial arteries are small branches that are distributed to these organs. LY N

O What do you think about the aorta and mediastina? Thoracic Duct The thoracic duct begins below in the abdomen as a dilated sac, THE CISTERNA CHYLI It ascends through the aortic opening in the diaphragm enters the beginning of the left brachiocephalic vein.

Passes through superior and posterior mediastinum n ly o ad e R thus conveys to the The thoracic duct blood all lymph from the lower limbs, pelvic cavity, abdominal cavity, left side of the thorax, and left side of the head, neck, and left arm Nerves of the Thorax Vagus Nerves Cranial nerve 10 The right vagus nerve

The left vagus nerve Located in the neck Thorax: passes through both superior and posterior mediastinum Phrenic Nerves The phrenic nerves arise from the anterior rami of the third, fourth, and fifth cervical nerves It passes in front of the root of the lungs ly

on ad Re Its terminal branches pass through the caval opening in the diaphragm to supply the central part of the peritoneum on its underaspect. Thoracic Part of the Sympathetic Trunk The thoracic part of the sympathetic trunk is continuous above with the cervical and below with the lumbar parts of the sympathetic trunk. : passes through

both superior and posterior mediastinum ad Re ly on The first ganglion is often fused with the inferior cervical ganglion to form the stellate ganglion The esophagus has

three anatomic and physiologic constrictions Esophagus is a tubular structure about 10 in. (25 cm) long is continuous above with the laryngeal part of the pharynx opposite the sixth cervical vertebra. It passes through the diaphragm at the level of the 10th thoracic vertebra to join the stomach where the

pharynx joins the upper end 1 2 ad Re These constrictions are ly on passes through both superior and posterior mediastinum

where the aortic arch and the left bronchus cross its anterior surface 3 where the esophagus passes through the diaphragm into the stomach

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