FirstRanker Logo

FirstRanker.com - FirstRanker's Choice is a hub of Question Papers & Study Materials for B-Tech, B.E, M-Tech, MCA, M.Sc, MBBS, BDS, MBA, B.Sc, Degree, B.Sc Nursing, B-Pharmacy, D-Pharmacy, MD, Medical, Dental, Engineering students. All services of FirstRanker.com are FREE

📱

Get the MBBS Question Bank Android App

Access previous years' papers, solved question papers, notes, and more on the go!

Install From Play Store

Download MBBS Anatomy PPT 46 Mediastinum Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Human Anatomy ppt lectures Topic 46 Mediastinum Notes. - anatomy ppt free download human anatomy ppt lectures, medicine notes ppt, anatomy handwritten notes pdf, mbbs 1st year anatomy notes pdf download, best anatomy notes pdf, human anatomy notes pdf, anatomy easy notes pdf, anatomy notes online, anatomy short notes, Anatomy ppt, Powerpoint Presentations and lecture notes.

This post was last modified on 05 April 2022


Learning Objectives

? Identify the divisions of the mediastinum and describe

--- Content provided by FirstRanker.com ---

their contents.

? Describe the gross anatomy of structures in

mediastinum.

--- Content provided by FirstRanker.com ---


? Describe the anatomy of nerves in the mediastinum.

? Correlate this knowledge to clinical conditions.

--- Content provided by FirstRanker.com ---

Boundaries of mediastinum

Thoracic inlet

Sternal Angle

--- Content provided by FirstRanker.com ---


sternum

Thoracic vertebra

--- Content provided by FirstRanker.com ---

Thoracic oulet

TS: Mediastinum

CS: Mediastinum

--- Content provided by FirstRanker.com ---


Mediastinum

? Bulky septum

--- Content provided by FirstRanker.com ---

between the

pleural cavities

& lungs

--- Content provided by FirstRanker.com ---


Extends-

? Root of the

--- Content provided by FirstRanker.com ---

neck to

diaphragm

? From the

--- Content provided by FirstRanker.com ---


sternum to

vertebral

--- Content provided by FirstRanker.com ---

column
Divisions of mediastinum

? Divided by an imaginary horizontal plane from

--- Content provided by FirstRanker.com ---

the sternal angle to the intervertebral disc

between 4th & 5th vertebra in to

? superior mediastinum

--- Content provided by FirstRanker.com ---

? Inferior mediastinum ?

Anterior Middle Posterior

DIVISIONS OF MEDIASTINUM

--- Content provided by FirstRanker.com ---


Boundaries Of Superior Mediastinum

BOUNDARIES:
? Anterior: manubrium sterni

--- Content provided by FirstRanker.com ---

? Posterior: Upper 4 thoracic vertebrae
? Superior: Plane of thoracic inlet
? Inferior: Horizontal plane
? On each side: Pleura

--- Content provided by FirstRanker.com ---


Superior mediastinum

SUPERIOR MEDIASTINUM

--- Content provided by FirstRanker.com ---

SUPERIOR MEDIASTINUM


LEFT

--- Content provided by FirstRanker.com ---

RIGHT
Superior mediastinum

? Posterior to the sternum & anterior to the

--- Content provided by FirstRanker.com ---

bodies of first four thoracic vertebra

Superior mediastinum

CONTENTS:

--- Content provided by FirstRanker.com ---


? FROM BEHIND FORWARD:

1.Esophagus

--- Content provided by FirstRanker.com ---

2.Trachea

3.Arch of aorta & its 3 branches: brachiocephalic,

left common carotid & left subclavian arteries

--- Content provided by FirstRanker.com ---


4.Right & left brachiocephalic veins & superior vena

cava

--- Content provided by FirstRanker.com ---

5.Thymus gland

Other Contents of superior mediastinum

Nerves:

--- Content provided by FirstRanker.com ---


1. Right & left vagus

2. Right & left phrenic

--- Content provided by FirstRanker.com ---

3. Right & left

sympathetic trunks

4. Left recurrent

--- Content provided by FirstRanker.com ---


laryngeal

Lymphatic structures:

--- Content provided by FirstRanker.com ---

1. Thoracic duct

2. Lymph nodes

Thymus

--- Content provided by FirstRanker.com ---


? Asymmetric bilobed gland

? Upper extent may reach as high as thyroid

--- Content provided by FirstRanker.com ---

gland

? Involved in early development of immune

system

--- Content provided by FirstRanker.com ---


? Large in children

? Atrophies after puberty
Brachiocephalic veins

--- Content provided by FirstRanker.com ---


?Located immediately

posterior to thymus

--- Content provided by FirstRanker.com ---

?Formed at the jn. of IJ

& subclavian veins.

? Begins post to clavicle

--- Content provided by FirstRanker.com ---


?Tributaries: vertebral,

first post. Intercostal,

--- Content provided by FirstRanker.com ---

int. thoracic, inf.

Thyroid, thymic veins

Left superior intercostal vein

--- Content provided by FirstRanker.com ---


? Drains upper two

or three

--- Content provided by FirstRanker.com ---

intercostal veins,

left bronchial

veins & left

--- Content provided by FirstRanker.com ---


pericardiophrenic

veins

--- Content provided by FirstRanker.com ---

? Drains in to left

brachiocephalic

veins

--- Content provided by FirstRanker.com ---


Superior vena cava

? Vertically oriented
? Begins posterior

--- Content provided by FirstRanker.com ---


to the lower edge

of first costal

--- Content provided by FirstRanker.com ---

cartilage

? terminates at the

lower border of

--- Content provided by FirstRanker.com ---


right third costal

cartilage

--- Content provided by FirstRanker.com ---

Arch of aorta & it's branches

? Begins when

ascending aorta

--- Content provided by FirstRanker.com ---


emerges from

pericardial sac

--- Content provided by FirstRanker.com ---

? Terminates on left side

of vertebral level

between Th 4th - 5th

--- Content provided by FirstRanker.com ---


Branches-

Brachiocephalic trunk

--- Content provided by FirstRanker.com ---

Left CCA
Left subclavian

Thyroid ima
Trachea

--- Content provided by FirstRanker.com ---


? Midline structure
? Present anterior to

esophagus

--- Content provided by FirstRanker.com ---


? Swallowing, breathing,

disease & specialized

--- Content provided by FirstRanker.com ---

instrumentation causes

shift of trachea

? divides just inferior to

--- Content provided by FirstRanker.com ---


sternal angle (T3- T4)

into Right & Left principal

--- Content provided by FirstRanker.com ---

bronchus

Vagus nerve

Right Vagus

--- Content provided by FirstRanker.com ---

? lies between right

brachiocephalic

vein & trunk

--- Content provided by FirstRanker.com ---


? Descends

posteriorly to the

--- Content provided by FirstRanker.com ---

root of Right lung

to reach

esophagus

--- Content provided by FirstRanker.com ---


? Gives branches to

esophagus,

--- Content provided by FirstRanker.com ---

cardiac plexus &

pulmonary plexus

Left Vagus nerve

--- Content provided by FirstRanker.com ---


? Lies between Lt CCA &

Lt subclavian artery

--- Content provided by FirstRanker.com ---

? Pass posterior to the

root of lung to reach the

esophagus

--- Content provided by FirstRanker.com ---


? Gives branches to

esophagus, cardiac &

--- Content provided by FirstRanker.com ---

pulmonary plexus

? Also gives Lt recurrent

laryngeal nerve- arise at

--- Content provided by FirstRanker.com ---


inferior margin of arch of

aorta, winds around the

--- Content provided by FirstRanker.com ---

aorta & reaches the

groove between

esophagus & trachea

--- Content provided by FirstRanker.com ---


Left recurrent laryngeal nerve

? arise at inferior

--- Content provided by FirstRanker.com ---

margin of arch of

aorta, winds around

the aorta & reaches

--- Content provided by FirstRanker.com ---


the groove between

esophagus &

--- Content provided by FirstRanker.com ---

trachea
Phrenic nerve

? Right Phrenic ?enters

--- Content provided by FirstRanker.com ---

lateral to Right Vagus

& beginning of Right

brachiocephalic vein

--- Content provided by FirstRanker.com ---


? continues inferiorly on

the Right side of sup

--- Content provided by FirstRanker.com ---

vena cava, on

entering middle

mediastinum

--- Content provided by FirstRanker.com ---


descends along the

Rt side of pericardial

--- Content provided by FirstRanker.com ---

sac anterior to the Rt

lung root

? leaves the thorax with

--- Content provided by FirstRanker.com ---


inferior vena cava

Left phrenic nerve

--- Content provided by FirstRanker.com ---

? enters similar to

Right Phrenic nerve

? Lateral to Vagus & Lt

--- Content provided by FirstRanker.com ---


brachiocephalic vein

? Descends on left

--- Content provided by FirstRanker.com ---

lateral surface of

arch of aorta

? Passes superficial to

--- Content provided by FirstRanker.com ---


Lt vagus & superior

intercostal vein

--- Content provided by FirstRanker.com ---

Left phrenic nerve

? In middle

mediastinum lies on

--- Content provided by FirstRanker.com ---


the Lt side of

pericardial sac

--- Content provided by FirstRanker.com ---

anterior to root of Lt

lung

? Pierces the

--- Content provided by FirstRanker.com ---


diaphragm near the

apex of the heart

--- Content provided by FirstRanker.com ---

Thoracic duct

? Major lymphatic vessel

of the body

--- Content provided by FirstRanker.com ---


? Enters sup.

mediastinum from

--- Content provided by FirstRanker.com ---

below at the level of

T4/5

? continues through the

--- Content provided by FirstRanker.com ---


superior med. posterior

to arch of aorta

--- Content provided by FirstRanker.com ---

between the esophagus

& Lt pleura


--- Content provided by FirstRanker.com ---

Anterior Mediastinum

Lies ant. to pericardium
Boundaries:

--- Content provided by FirstRanker.com ---

Anterior: body of sternum

Posterior: pericardium

superior: imaginary line

--- Content provided by FirstRanker.com ---


separating sup. &

inf.mediastinum

--- Content provided by FirstRanker.com ---

Infreior: diaphragm

Lateral: mediastinal pleura

Anterior mediastinum

--- Content provided by FirstRanker.com ---


Thymus

contains:

--- Content provided by FirstRanker.com ---

Lymph nodes
fat

Thymus

--- Content provided by FirstRanker.com ---

Located in anterior

mediastinum.
Develops from endoderm

--- Content provided by FirstRanker.com ---

of 3rd pharyngeal pouch

Present in childhood,

involutes in adults

--- Content provided by FirstRanker.com ---

Blood supply

Arterial :i nt. Mammary arteries

Venous: internal thoracic veins

--- Content provided by FirstRanker.com ---


Lymphatic drainage: lower

cervical, int. Mammary and hilar

--- Content provided by FirstRanker.com ---

nodes
Esophagus

? Starts at the C6th &

--- Content provided by FirstRanker.com ---

terminates at cardiac

opening of stomach

(T12)

--- Content provided by FirstRanker.com ---


? Descends anterior to

vertebral bodies in

--- Content provided by FirstRanker.com ---

midline

? Crossed laterally by the

azygos vein on the right

--- Content provided by FirstRanker.com ---


side & arch of aorta on

the left side

--- Content provided by FirstRanker.com ---

Posterior Mediastinum

BOUNDARIES:
? Anterior: Pericardium & diaphragm
? Posterior: Lower 8 thoracic vertebrae

--- Content provided by FirstRanker.com ---

? Superior: Horizontal plane
? Inferior: Diaphragm
? On each side: Pleura

Posterior Mediastinum

--- Content provided by FirstRanker.com ---


? CONTENTS:

1. Esophagus (most anterior structure)

--- Content provided by FirstRanker.com ---

2. Thoracic duct

3. Right & left vagus

4. Descending aorta

--- Content provided by FirstRanker.com ---


5. Azygos & hemiazygos veins

6. Right & left sympathetic trunks & their

--- Content provided by FirstRanker.com ---

branches (splanchnic nerves)

7. Lymph nodes

POSTERIOR MEDIASTINUM

--- Content provided by FirstRanker.com ---

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

POSTERIOR MEDIASTINUM

--- Content provided by FirstRanker.com ---


POSTERIOR MEDIASTINUM


MIDDLE MEDIASTINUM

--- Content provided by FirstRanker.com ---


? CONTENTS:

1. Pericardium & heart

--- Content provided by FirstRanker.com ---

2. Arteries: ascending aorta, pulmonary trunk

3. Veins: lower half of superior vena cava,

terminations of inferior vena cava & pulmonary

--- Content provided by FirstRanker.com ---


veins

4. Nerves: phrenic

--- Content provided by FirstRanker.com ---

5. Lymph nodes

Mediastinum

VEINS

--- Content provided by FirstRanker.com ---


BRACHIOCEPHALIC: (Superior mediastinum)

? FORMATION: by union of internal jugular & subclavian vein

--- Content provided by FirstRanker.com ---

(behind medial end of clavicle)

? END: Both veins unite to form S.V.C.

? RIGHT VEIN: shorter & has a vertical course, related lateral y to

--- Content provided by FirstRanker.com ---


right phrenic nerve & right pleura & lung, its tributaries in thorax:

right 1st posterior intercostal vein, right internal thoracic vein,

--- Content provided by FirstRanker.com ---

right lymphatic duct

? LEFT VEIN: longer & has an oblique course, related anteriorly to

manubrium & thymus gland, & posteriorly to branches of arch of

--- Content provided by FirstRanker.com ---


aorta, its tributaries in thorax: left 1st posterior intercostal vein,

left superior intercostal vein, left internal thoracic vein, thoracic

--- Content provided by FirstRanker.com ---

duct

VEINS

SUPERIOR VENA CAVA: (Superior & middle mediastinum)

--- Content provided by FirstRanker.com ---


? FORMATION: by union of brachiocephalic veins, behind lower border of

right 1st costal cartilage

--- Content provided by FirstRanker.com ---

? END: opens into right atrium behind right 3rd costal cartilage
? TRIBUTARIES: azygos vein


AZYGOS & HEMIAZYGOS VEINS

--- Content provided by FirstRanker.com ---


VEINS
AZYGOS VEIN: (Posterior mediastinum)

?

--- Content provided by FirstRanker.com ---


ORIGIN: by union of right ascending lumbar & subcostal veins

(passes through aortic opening of diaphragm)

--- Content provided by FirstRanker.com ---

?

END: forms an arch above the root of right lung & ends in S.V.C.

opposite lower border of T4

--- Content provided by FirstRanker.com ---


?

RELATIONS:

--- Content provided by FirstRanker.com ---

1. Anterior: esophagus

2. Posterior: thoracic vertebra

3. Right: right pleura & lung

--- Content provided by FirstRanker.com ---


4. Left: thoracic duct

?

--- Content provided by FirstRanker.com ---

TRIBUTARIES: superior & inferior hemiazygos veins, right

superior intercostal vein, right posterior intercostal veins (from

4th to 11th), right bronchial veins, esophageal & pericardial veins

--- Content provided by FirstRanker.com ---


VEINS

INFERIOR HEMIAZYGOS: (Posterior

--- Content provided by FirstRanker.com ---

mediastinum)

?ORIGIN: by union of left ascending lumbar

& subcostal veins (passes through left crus

--- Content provided by FirstRanker.com ---


of diaphragm)

?END: into azygos vein, opposite T8

--- Content provided by FirstRanker.com ---

?TRIBUTARIES: left posterior intercostal

veins (9th to 11th), esophageal veins

VEINS

--- Content provided by FirstRanker.com ---


SUPERIOR HEMIAZYGOS: (Posterior mediastinum)

? ORIGIN: by left posterior intercostal veins (4th to 8th)

--- Content provided by FirstRanker.com ---

? END: into azygos vein, opposite T7

? TRIBUTARIES: left bronchial veins
INFERIOR VENA CAVA: (Posterior mediastinum)

--- Content provided by FirstRanker.com ---

? END: passes through vena caval opening of diaphragm

& opens into right atrium behind right 6th costal

cartilage

--- Content provided by FirstRanker.com ---

Ar
A te

ORT rAi:

--- Content provided by FirstRanker.com ---

?

ASCEND e

IN s

--- Content provided by FirstRanker.com ---


G AORTA: (Middle mediastinum)

1. ORIGIN: at the base of left ventricle opposite lower border of left 3rd

--- Content provided by FirstRanker.com ---

costal cartilage

2. END: ascends upward, forward & to the right & continues as arch of

aorta

--- Content provided by FirstRanker.com ---


3. BRANCHES: right & left coronary arteries

Ar
? te

--- Content provided by FirstRanker.com ---


ARrCieH sOF AORTA: (Superior mediastinum)

1. ORIGIN: continuation of ascending aorta, opposite upper border of

--- Content provided by FirstRanker.com ---

right 2nd costal cartilage

2. COURSE & RELATIONS: ascends upward backward & to the left

(behind manubrium & in front of trachea) then curves backward (to

--- Content provided by FirstRanker.com ---


the left of trachea) then final y curves downward

3. TERMINATION: continues as descending aorta, opposite lower border

--- Content provided by FirstRanker.com ---

of T4

Ar
?

--- Content provided by FirstRanker.com ---

teBRArNiCHeESs OF ARCH OF AORTA: (Superior mediastinum)

1. BRACHIOCEPHALIC: ascends upward & to the right (behind

left brachiocephalic vein & in front of trachea) & divides

--- Content provided by FirstRanker.com ---


into right common carotid & right subclavian arteries

(behind right sternoclavicular joint)

--- Content provided by FirstRanker.com ---

2. LEFT COMMON CAROTID: ascends upward & to the left (to

the left side of brachiocephalic artery) & enters the neck

(behind left sternoclavicular joint)

--- Content provided by FirstRanker.com ---


3. LEFT SUBCLAVIAN: ascends upward (behind left common

carotid artery, in front of esophagus, to the left side of

--- Content provided by FirstRanker.com ---

trachea), arches over apex of left lung to enter neck

Ar
DES te

--- Content provided by FirstRanker.com ---

CENDI rNie

G AO sRTA: (Posterior mediastinum)

?

--- Content provided by FirstRanker.com ---


ORIGIN: continuation of arch of aorta

?

--- Content provided by FirstRanker.com ---

TERMINATION: passes through aortic opening of

diaphragm (opposite T12) & continues as abdominal aorta

?

--- Content provided by FirstRanker.com ---


RELATIONS:

1. Anterior: esophagus

--- Content provided by FirstRanker.com ---

2. Posterior: thoracic vertebrae

3. Right: thoracic duct

4. Left: left pleura & lung

--- Content provided by FirstRanker.com ---


?

BRANCHES: posterior intercostal (from 3rd to 11th),

--- Content provided by FirstRanker.com ---

subcostal, bronchial, esophageal, pericardial arteries
Ar
PUL te

MON rARiYe TRsUNK (Middle mediastinum)

--- Content provided by FirstRanker.com ---


? ORIGIN: from upper part of right ventricle, behind

sternal end of left 3rd costal cartilage

--- Content provided by FirstRanker.com ---

? COURSE: ascends upward & to the left & divides (at

lower border of T4) into:

1. Right pulmonary: runs behind ascending aorta &

--- Content provided by FirstRanker.com ---


S.V.C to enter root of right lung

2. Left pulmonary: runs in front of desending aorta to

--- Content provided by FirstRanker.com ---

enter root of left lung

T
? RAC

--- Content provided by FirstRanker.com ---

BEGIN H

NIN EA

G: continuation of larynx, opposite C6

--- Content provided by FirstRanker.com ---


? TERMINATION: bifurcates into 2 bronchi, opposite lower border

of T4

--- Content provided by FirstRanker.com ---

? RELATIONS: (in superior mediastinum)

1. Anterior: arch of aorta, brachiocephalic & left common carotid

arteries

--- Content provided by FirstRanker.com ---


2. Posterior: left recurrent laryngeal nerve, esophagus

3. Right: right vagus nerve

--- Content provided by FirstRanker.com ---

4. Left: arch of aorta, left subclavian artery

? NERVE SUPPLY: sympathetic trunks & vagus

? BLOOD SUPPLY: inferior thyroid vessels

--- Content provided by FirstRanker.com ---


? LYMPHATIC DRAINAGE: pretracheal & paratracheal

ESOP
? BEGINNI H

--- Content provided by FirstRanker.com ---


NG: AG

contin UuatiSon of pharynx, opposite C6

--- Content provided by FirstRanker.com ---

? TERMINATION: passes through esophageal opening of diaphragm

(opposite T10) & joins stomach

? RELATIONS: (in superior mediastinum)

--- Content provided by FirstRanker.com ---


1. Anterior: left recurrent laryngeal nerve, trachea, left subclavian artery

2. Posterior: thoracic vertebrae

--- Content provided by FirstRanker.com ---

3. Right: right pleura & lung

4. Left: thoracic duct, left pleura & lung

ESOP?RELATIHONAGS: (inU pSosterior mediastinum)

--- Content provided by FirstRanker.com ---


1.Anterior: pericardium, separating it from left atrium

2.Posterior: thoracic duct, descending aorta, azygos vein

--- Content provided by FirstRanker.com ---

3.Right: right pleura & lung

4.Left: descending aorta, left pleura & lung

? NERVE SUPPLY: as trachea

--- Content provided by FirstRanker.com ---


? ARTERIAL SUPPLY: descending aorta

? VENOUS DRAINAGE: azygos & hemiazygos

--- Content provided by FirstRanker.com ---

? LYMPHATIC DRAINAGE: posterior mediastinal lymph

nodes
THORACIC DUCT
? ORIGIN: from upper end of cysterna chyli (opposite

--- Content provided by FirstRanker.com ---


L1 & L2)

? COURSE: passes through aortic opening of

--- Content provided by FirstRanker.com ---

diaphragm, ascends in posterior mediastinum

(behind esophagus) & in superior mediastinum (to

the left of esophagus) to enter root of neck

--- Content provided by FirstRanker.com ---


? END: in left brachiocephalic vein

? RELATIONS: ( in posterior mediastinum)

--- Content provided by FirstRanker.com ---

1. Anterior: esophagus

2. Posterior: thoracic vertebrae

3. Right: azygos vein

--- Content provided by FirstRanker.com ---


4. Left: descending aorta

THORACIC DUCT

--- Content provided by FirstRanker.com ---

TRIBUTARIES:

? It drains lymph from both sides of the body below

the diaphragm through cysterna chyli

--- Content provided by FirstRanker.com ---


? It drains lymph from left half of the body above

diaphragm through:

--- Content provided by FirstRanker.com ---

1. Left jugular lymph trunk: drains left side of head &

neck

2. Left subclavian lymph trunk: drains left upper limb

--- Content provided by FirstRanker.com ---


3. Left bronchomediastinal lymph trunk: drains left

side of thorax

--- Content provided by FirstRanker.com ---

RIGHT LYMPHATIC DUCT

? ORIGIN: formed by union of:

1. Right jugular lymph trunk: drains right

--- Content provided by FirstRanker.com ---


side of head & neck

2. Right subclavian lymph trunk: drains

--- Content provided by FirstRanker.com ---

right upper limb

3. Right bronchomediastinal lymph trunk:

drains right side of thorax

--- Content provided by FirstRanker.com ---


? END: in right brachiocephalic vein

NERVES
PHRENIC NERVES: (Superior & middle mediastinum)

--- Content provided by FirstRanker.com ---


?

ORIGIN: anterior rami of C3,4,5

--- Content provided by FirstRanker.com ---

?

COURSE & RELATIONS IN THORAX:

1. RIGHT: descends to the right side of: right brachiocephalic vein,

--- Content provided by FirstRanker.com ---


S.V.C., pericardium, I.V.C.

2. LEFT: descends to the left side of: arch aorta, pericardium

--- Content provided by FirstRanker.com ---

?

BRANCHES:

1. Motor branches to: diaphragm

--- Content provided by FirstRanker.com ---


2. Sensory branches from:

?

--- Content provided by FirstRanker.com ---

Mediastinal & central part of diaphragmatic pleura

?

Fibrous pericardium & parietal layer of serous pericardium

--- Content provided by FirstRanker.com ---


?

Peritoneum covering central part of undersurface of diaphragm
NERVES

--- Content provided by FirstRanker.com ---

? VAGUS NERVES: (Superior & posterior mediastinum)

? ORIGIN: 10th cranial nerve

? COURSE & RELATIONS IN THORAX:

--- Content provided by FirstRanker.com ---


1. RIGHT: descends to the right side of: trachea, behind

root of right lung (pulmonary plexus), behind

--- Content provided by FirstRanker.com ---

esophagus (esophageal plexus), passes through

esophageal opening of diaphragm to reach posterior

surface of stomach

--- Content provided by FirstRanker.com ---


2. LEFT: descends to the left side of: arch aorta, behind

root of left lung (pulmonary plexus), in front of

--- Content provided by FirstRanker.com ---

esophagus (esophageal plexus), passes through

esophageal opening of diaphragm to reach anterior

surface of stomach

--- Content provided by FirstRanker.com ---


NERVES

BRANCHES IN THORAX:

--- Content provided by FirstRanker.com ---

? BOTH VAGI: to lungs & esophagus

? RIGHT VAGUS: to heart

? LEFT VAGUS: left recurrent laryngeal nerve:

--- Content provided by FirstRanker.com ---


curves below arch of aorta, behind ligamentum

arteriosum, ascends in groove between trachea

--- Content provided by FirstRanker.com ---

& esophagus to reach the neck. It supplies: heart,

trachea, esophagus (in thorax) & larynx (in neck)

NERVES

--- Content provided by FirstRanker.com ---

THORACIC PART OF SYMPATHETIC TRUNKS: (Superior &

posterior mediastinum)

? BEGINNING: the cervical part continues as thoracic

--- Content provided by FirstRanker.com ---


part by passing in front of neck of first rib

? TERMINATION: the thoracic part continues as lumbar

--- Content provided by FirstRanker.com ---

part by passing behind medial arcuate ligament

? COURSE:

1. In upper part of thorax: descend in front of heads of

--- Content provided by FirstRanker.com ---


ribs

2. In lower part of thorax: descend on the sides of

--- Content provided by FirstRanker.com ---

bodies of vertebrae

? GANGLIA: usual y 11 (1st thoracic ganglion fuses with

inferior cervical ganglion forming stel ate ganglion)

--- Content provided by FirstRanker.com ---


NERVES

?

--- Content provided by FirstRanker.com ---

BRANCHES:

1. Rami communicantes: each ganglion receives a

white ramus (preganglionic) & gives a grey ramus

--- Content provided by FirstRanker.com ---


(postganglionic) to corresponding thoracic spinal

nerve

--- Content provided by FirstRanker.com ---

2. Visceral branches (postganglionic) to thoracic organs

(from upper 5 ganglia): to heart, lungs, esophagus,

descending aorta

--- Content provided by FirstRanker.com ---


3. Visceral branches (preganglionic) to abdominal

organs:

--- Content provided by FirstRanker.com ---

? Greater splanchnic nerve (from 5th to 9th ganglia)

? Lesser splanchnic nerve (from 10th 7 11th ganglia)

? Lowest splanchnic nerve (from 12th ganglion)

--- Content provided by FirstRanker.com ---





Nerves in mediastinum

--- Content provided by FirstRanker.com ---


? The right vagus nerve descends in

the thorax, first posterolateral to the

--- Content provided by FirstRanker.com ---

brachiocephalic artery then lateral

to the trachea

? Passes behind the root of the right

--- Content provided by FirstRanker.com ---


lung and assists in the formation of

the pulmonary plexus.

--- Content provided by FirstRanker.com ---

? On leaving the plexus, the vagus

passes onto the posterior surface of

the esophagus and takes part in the

--- Content provided by FirstRanker.com ---


formation of the esophageal

plexus.

--- Content provided by FirstRanker.com ---

? It then passes through the

esophageal opening of the

diaphragm.

--- Content provided by FirstRanker.com ---


Nerves in mediastinum
? The left vagus nerve descends in

the thorax between the left

--- Content provided by FirstRanker.com ---


common carotid and the left

subclavian arteries

--- Content provided by FirstRanker.com ---

? It then crosses the left side of the

aortic arch

? The vagus then turns backward

--- Content provided by FirstRanker.com ---


behind the root of the left lung and

assists in the formation of the

--- Content provided by FirstRanker.com ---

pulmonary plexus.

? On leaving the plexus, the vagus

passes onto the anterior surface of

--- Content provided by FirstRanker.com ---


the esophagus and takes part in

the formation of the esophageal

--- Content provided by FirstRanker.com ---

plexus.

Nerves in mediastinum
? The right phrenic nerve

--- Content provided by FirstRanker.com ---

descends in the thorax along the

right side of the right

brachiocephalic vein and the

--- Content provided by FirstRanker.com ---


superior vena cava .

? It passes in front of the root of

--- Content provided by FirstRanker.com ---

the right lung and runs along the

right side of the pericardium, which

separates the nerve from the right

--- Content provided by FirstRanker.com ---


atrium.

? It then descends on the right side

--- Content provided by FirstRanker.com ---

of the inferior vena cava to t`he

diaphragm.

? Its terminal branches pass through

--- Content provided by FirstRanker.com ---


the caval opening in the

diaphragm to supply the central

--- Content provided by FirstRanker.com ---

part of the peritoneum on its under

aspect.

Nerves in mediastinum

--- Content provided by FirstRanker.com ---

? The left phrenic nerve descends

in the thorax along the left side of

the left subclavian artery.

--- Content provided by FirstRanker.com ---


? It crosses the left side of the aortic

arch and here crosses the left side

--- Content provided by FirstRanker.com ---

of the left vagus nerve.

? It passes in front of the root of the

left lung and then descends over

--- Content provided by FirstRanker.com ---


the left surface of the pericardium,

which separates the nerve from

--- Content provided by FirstRanker.com ---

the left ventricle.

? On reaching the diaphragm, the

terminal branches pierce the

--- Content provided by FirstRanker.com ---


muscle and supply the central part

of the peritoneum on its under

--- Content provided by FirstRanker.com ---

aspect.
anatomical

Acc. To felson

--- Content provided by FirstRanker.com ---

Clinical correlations
? Deflection of Mediastinum
?If air enters the pleural

cavity (a condition called

--- Content provided by FirstRanker.com ---


pneumothorax), the lung

on that side immediately

--- Content provided by FirstRanker.com ---

collapses and the

mediastinum is displaced to

the opposite side.

--- Content provided by FirstRanker.com ---


?patient's being breathless

and in a state of shock; on

--- Content provided by FirstRanker.com ---

examination, the trachea

and the heart are found to

be displaced to the opposite

--- Content provided by FirstRanker.com ---


side


Clinical correlations

--- Content provided by FirstRanker.com ---

? Mediastinitis
?Deep infection of the neck spread readily into the thorax,

producing a mediastinitis.

--- Content provided by FirstRanker.com ---

?Penetrating wounds of the chest involving the esophagus

may produce a mediastinitis.

Clinical correlations

--- Content provided by FirstRanker.com ---


? Mediastinal Tumors or Cysts
?Enlargement of mediastinal tumor

may compress the left recurrent

--- Content provided by FirstRanker.com ---


laryngeal nerve, producing

paralysis of the left vocal fold.

--- Content provided by FirstRanker.com ---

?An expanding cyst or tumor can

partially occlude the superior vena

cava, causing severe congestion

--- Content provided by FirstRanker.com ---


of the veins of the upper part of

the body.

--- Content provided by FirstRanker.com ---

?Other pressure effects can be

seen on the sympathetic trunks,

phrenic nerves, and sometimes

--- Content provided by FirstRanker.com ---


the trachea, main bronchi, and

esophagus.

--- Content provided by FirstRanker.com ---

Clinical correlations
? Mediastinoscopy

?diagnostic procedure by which

--- Content provided by FirstRanker.com ---

tracheobronchial lymph nodes

are obtained without opening the

pleural cavities.

--- Content provided by FirstRanker.com ---


?A small incision is made in the

midline in the neck just above

--- Content provided by FirstRanker.com ---

the suprasternal notch, and

the superior mediastinum is

explored down to the region of

--- Content provided by FirstRanker.com ---


the bifurcation of the trachea.

?The procedure can be used to

--- Content provided by FirstRanker.com ---

determine the diagnosis and

degree of spread of carcinoma

of the bronchus.

--- Content provided by FirstRanker.com ---


Summary
? Mediastinum: definition
? Extend and sub

--- Content provided by FirstRanker.com ---

divisions

? Contents
? Nerves passing thorax
? Clinical correlations

--- Content provided by FirstRanker.com ---