HFD
2016
Spudich
Learning Objectives
Mediastinum
Space between the
pulmonary cavities
Extends from the
superior thoracic
aperture to diaphragm
Covered with
mediastinal pleura
Highly Mobile
Loose C.T.
Hollow viscera
Accommodates
movement and pressure
changes
Superior Mediastinum
Inferior border is a line
through the sternal angle
Anterior Mediastinum
Deep to sternum
From sternal angle to
diaphragm
Fat
Nodes
Pericardial ligaments
Inferior lobe of thymus
Internal thoracic vessels
Middle Mediastinum
Deep to anterior
mediastinum
From angle to diaphragm
Pericardium,
Heart
Ascending aorta,
Pulmonary trunk, and veins
SVC
Arch of azygos v.,
Main bronchi
6
Posterior Mediastinum
Just ventral to Thoracic
vertebrae 5-12
Extends posterior to
diaphragm
Thoracic aorta
Thoracic duct
Azygos system vessels
Esophagus
Thoracic Sympathetic
trunk
Thoracic Splanchnic
nerves
Superior Mediastinum
Superior Mediastinum
Thymus
Deep to the manubrium
Superficial to the pericardium
Great Vessels
Brachiocephalic Veins
Form deep to Sternoclavicular
joints
10
Great Vessels
Right Brachiocephalic
Vein
Receives Right
Lymphatic duct
Brachiocephalic Veins
join to form the SVC
Dorsal and to ascending
aorta
11
Great Vessels/SVC
SVC
Receives blood from all
structures superior to the
diaphragm EXCEPT heart
and lung parenchyma
Right side of mediastinum
Right Phrenic nerve lateral
and between SVC and
Mediastinal pleura
12
Ligamentum arteriosum
Medial to Recurrent Laryngeal n
Fetal remnant
13
Divides at sternoclavicular
joint level
Right subclavian
Deep to the anterior scalene
muscles
Common carotid
14
Posterior Mediastinum
22
Thoracic Aorta
Begins at the T4 body/
iv disc
Posterior to the root of
left lung, esophagus and
pericardium
Continues to the
abdomen through the
aortic Hiatus in the
diaphragm
T12
23
Thoracic Aorta
Posteriorly and laterally
the branches are paired
Posterior Intercostals
and subcostals
Considered mostly
parietal
25
Esophagus
Long hollow fibro-muscular
tube
Superior and posterior
mediastinum
26
Esophagus
Points of constriction
Junction with Pharynx
Aortic arch
Left main bronchus
Diaphragm
physiological
27
Esophagus
Blood supply from the
bronchial and
esophageal arteries off
the thoracic aorta
Autonomic innervation
is from Esophageal
plexus
Derived from CNX and
Sympathetic trunk
28
Azygos vein
29
30
31
Greater
T5-T9/10
Celiac ganglia
Lesser
T10-11
Aorticorenal
Least
T12
SM and IM ganglia and
plexuses
33
34
35
Diaphragm
Domed partition of
variable position
Muscle fibers
Central tendon
36
Blood Supply
to Diaphragm
Thoracic origin
Pericardiocophrenics (w/
vv)
Musculophrenics ( w/ vv)
Superior phrenics
Abdominal origin
Inferior Phrenics (w/vv)
37
Sensory Innervation
Phrenic (referred pain to shoulder/neck) serves
central regions
Intercostal and Subcostal nerves (local pain along
region of trunk )
38
39
40
41
42