SUPERIOR MEDIASTINUM AND LUNGS

Topographic Anatomy

Structure/S
pace

Description/Boundaries

Significance

sternal angle

the junction of the

manubrium and body of the
sternum

it is an anterior projection located at the level

of the costal cartilage of rib 2; an important
landmark for internal thoracic anatomy

superior
mediastinum

superior to the transverse

plane passing through the
sternal angle and the
junction of vertebrae T4/T5

main contents include: thymus,

brachiocephalic veins, superior vena cava,
aortic arch and the roots of its major
branches, vagus (X) and phrenic nerves, left
recurrent laryngeal n., trachea, esophagus,
thoracic duct (Latin, medius = middle + stare
= stand, thus the area which stands in the
middle of the thorax)

Arteries

Artery

Source

Branches

Supply to

Notes

aorta,
ascending

left ventricle
of the heart

left and right

coronary aa.

heart, entire
body

ascending aorta is the

shortest part of the
aorta; it continues as
the aortic arch

aortic arch

the
continuation
of the
ascending
aorta

brachiocephalic
trunk, left common
carotid a., left
subclavian a.

the entire
body except
the heart

aortic arch continues

as the descending
thoracic aorta; the
fibrous ligamentum
arteriosum connects to
the inferior surface of
the aortic arch and it
marks the location of
the fetal ductus
arteriosus aortic arch
continues as the
descending thoracic
aorta (Greek, aorta =
to lift)

brachiocephalic
trunk

aortic arch

right common
carotid a., right
subclavian a.

right side of
the head
and neck;
right upper
limb and
right side of
the chest
wall

there is only one

brachiocephalic
trunk (Greek/Latin,
bracchium = arm +
kephale = head)

carotid,

brachioceph

external carotid a.,

most of the

common carotid a.

common

alic trunk
(right), aortic
arch (left)

internal carotid a.

head and
upper neck

bifurcates at the level

of the superior border
of the thyroid
cartilage; the internal
carotid a. and the
external carotid a. are
its terminal brs.; the
carotid sinus and
carotid body are
located at the
bifurcation (Greek,
kara = head)

subclavian

brachioceph
alic a. (right),
aortic arch
(left)

1st part: vertebral

a., thyrocervical
trunk, internal
thoracic a.; 2nd
part: costocervical
trunk; 3rd part:
dorsal scapular a.
(70%)

neck, brain,
spinal cord,
thyroid
gland,
larynx,
shoulder,
chest
muscles,
upper limb

subclavian a. is
continuous with the
axillary a., the name
change occurs at the
lateral border of the
first rib; anterior
scalene muscle passes
anterior to the
subclavian a., dividing
it into 3
parts ("clavian" refers
to the clavicle)

thoracic,
internal

subclavian a.
(1st part)

pericardiacophreni
c a., perforating
brs., anterior
intercostal aa.,
mediastinal brs.,
thymic brs.,
musculophrenic a.,
superior epigastric
a.

mediastinum
, anterior
thoracic
wall,
anterior
abdominal
wall,
respiratory
diaphragm

internal thoracic a. is
also known as: internal
mammary a.

pericardiacophr
enic

internal
thoracic a.

pericardial br.,
sternal br.,
mediastinal br.

pericardial
sac, pleura,
diaphragm

pericardiacophrenic a.
accompanies the
phrenic n.

bronchial, left

descending
thoracic
aorta

right bronchial
(occasionally)

lower
trachea,
bronchial
tree

usually 2 in number

Veins

Vein
azygos

Tributaries

Drains Into

Region
Drained

Notes

union of ascending
sup. vena cava lateral & post.
may connect with inf.
lumbar & subcostal;
abdominal/chest vena cava; arch of
post. intercostals 11-2
wall, esophagus, azygos passes sup. to
(rt. sup. intercostal),
bronchial tree
root of lung (Greek,ahemiazygos, accessory
= not + zygon =
hemiazygos,
yoke, therefore

esophageal, rt.
bronchial

unyoked or unpaired,
as the azygos vein)

brachioceph union of subclavian &

alic
internal jugular;
vertebral, thymic,
inferior thyroid,
internal thoracic, 1st
post. intercostal, left
sup. intercostal (to left
brachiocephalic)

left & right

brachiocephali
c unite to form
sup. vena cava

head, neck,
upper limb,
anterior chest
wall

intercostal,
superior

2nd-4th posterior
intercostal

right: arch of
intercostal
azygos; left:
spaces 2-4
left
brachiocephali
c

thoracic,
internal

union of
musculophrenic and
superior epigastric;
ant. intercostal,
perforating

right - superior
vena cava; left
- left
brachiocephali
c

anterior chest
wall and upper
anterior
abdominal wall

thymic

left
thymus (or
brachiocephali thymic fat in
c
adult)

thyroid,
inferior

left
thyroid gland
brachiocephali inferiorly
c

vena cava,
superior

union of paired
brachiocephalics;
azygos arch

rt. atrium

at its origin, left

brachiocephalic
receives thoracic duct,
right receives right
lymphatic duct

body above
diaphragm
except for
pulmonary vs. &
heart

Lymphatics

Structure

Location

Afferents
from

Efferents to

Regions
drained

Notes

pulmonary
nodes

within the
lung
parenchy
ma

lymphatic
vessels from
the
parenchyma of
the lung

bronchopulmon
ary (hilar)
nodes

lung
parenchy
ma,
bronchial
tree within
the lungs

pulmonary
nodes are
located along
the larger
bronchi of the
lung

bronchopulmo
nary nodes

hilum of
the lung

pulmonary
nodes

tracheobronchi
al nodes

lung

bronchopulmo
nary nodes are
also known as:
hilar nodes

tracheobronchi
al nodes,
inferior

inferior to
tracheal
bifurcatio
n

bronchopulmo
nary nodes,
left side
inferior
tracheobronchi

right superior
tracheobronchi
al nodes

lower
lobes of
the lungs;
middle
mediastin

left inferior
tracheobronchi
al nodes drain
to the right
side

al nodes drain
into right
inferior
tracheobronchi
al nodes

um;
posterior
mediastin
um

tracheobronchi
al nodes,
superior

superolate
ral to the
tracheal
bifurcatio
n

bronchopulmo
nary (hilar)
nodes

paratracheal
(tracheal)
nodes

lungs,
middle
mediastin
um,
posterior
mediastin
um

inferior
tracheobronchi
al nodes drain
lymph from
the lower lobe
of the left lung
to the right
superior
tracheobronchi
al nodes

tracheal
(paratracheal)
nodes

coursing
along the
lateral
surface of
the
trachea
and
esophagu
s

superior
tracheobronchi
al nodes

bronchomedias
tinal trunk

lungs,
trachea,
upper
esophagus
, the part
of the
larynx
below the
vocal folds

paratracheal
nodes are an
important
group of nodes
in cases of
pulmonary
infection or
lung cancer;
also known as:
tracheal nodes

Nerves

Nerve

Source

Branches

phrenic
n.

ventral primary
rami of spinal
nerves C3-C5
(cervical
plexus)

no named
branches

vagus
n.

medulla: dorsal
motor nucleus
(GVE
preganglionic
parasympathet
ic); inferior
ganglion (GVA);
nucleus

auricular
br.,
pharyngea
l br.,
superior
laryngeal,
superior
and

Motor

Sensory

Notes

skeletal muscle
of the
respiratory
diaphragm

diaphragma
tic pleura;
some fibers
contributed
to the
pericardium
and to the
adjacent
mediastinal
and costal
pleurae

phrenic n. crosses
the anterior
surface of the
anterior scalene
m.(Greek, phren
= diaphragm, for
which we derive
the word
"frenzy," for the
diaphragm was
considered to be
the seat of
emotions)

SVE: intrinsic
muscles of the
larynx, pharynx
(except
stylopharyngeus
), and palate
(except tensor
veli palatini);

GSA: skin of
the external
auditory
meatus;
GVA: viscera
of head,
neck, thorax
& abdomen

also known as:

CN X, 10th cranial
nerve; the vagus
n. passes through
the jugular
foramen to exit
the posterior
cranial

ambiguus
(SVE); superior
ganglion
(GSA); inferior
ganglion(SVA)

inferior
cervical
cardiac
brs.,
recurrent
laryngeal
n.,
thoracic
cardiac
brs., brs.
to the
pulmonary
plexus,
brs. to the
esophage
al plexus,
anterior
and
posterior
vagal
trunks

GVE: smooth
muscle of the
respiratory tree
& gut (proximal
to the left colic
flexure), heart;
secretomotor:
mucous glands
of the larynx,
respiratory tree,
pharynx and
gut;
secretomotor to
digestive glands

proximal to
the left colic
flexure;
SVA: taste
from the
epiglottis

fossa; (Latin,
vagus =
wanderer, so
called because of
its wide
distribution to the
body cavities)

recurren
t
laryngea
l n.

vagus n. (X)

esophage
al brs.,
tracheal
brs.,
cardiac
brs.,
pharyngea
l brs.,
inferior
laryngeal
n.

upper
esophagus,
lower pharynx,
laryngeal mm.
(except
cricopharyngeus
); smooth
muscle of the
trachea;
secretomotor to
mucosal glands
in the upper
esophagus,
lower pharynx,
larynx below the
vocal fold,
trachea; cardiac
muscle of the
heart (slows
heart rate,
decreases force
of contraction)

upper
esophagus,
lower
pharynx,
larynx
below the
vocal folds,
GVA from
heart

right recurrent
laryngeal n. loops
posteriorly
around the right
subclavian a.; left
recurrent
laryngeal n. loops
posteriorly
around the aortic
arch and
ligamentum
arteriosum; the
inferior laryngeal
br. supplies all
intrinsic muscles
of the larynx
EXCEPT the
cricothyroid m.

cardiac
plexus

cardiac brs. of
the vagus n.
and cervical
sympathetic
trunk; thoracic
visceral nn.

no named
branches

moderates heart
muscle
(parasympatheti
c: decreases
rate and force of
contraction;
sympathetic:
increases rate
and force of
contraction);
vascular smooth
muscle of the
heart & lungs
(sympathetic);
smooth muscle

pain from
the heart
and lungs

cardiac plexus is
continuous with
the coronary and
pulmonary
plexuses;
thoracic visceral
nn. carry pain
from the heart to
the upper
thoracic spinal
cord segments
resulting in pain
referred to the
left upper limb in
the T1 and T2

& mucous
glands of
bronchial tree
(parasympatheti
c)

pulmona
ry
plexus

continuous
with cardiac
plexus,
thoracic
visceral ns.,
pulmonary brs.
of vagus

smooth muscle
& glands of
bronchial tree
(parasymp.);
vascular smooth
muscle of lungs
(symp.)

dermatomes (Lati
n, plexus = a
braid, a network
of nerves, blood
vessels, or
lymphatic
vessels)
located
along
pulmonary
vessels &
primary
bronchi in
root of lung

(Latin, plexus = a
braid, a network
of nerves, blood
vessels, or
lymphatic
vessels)

Viscera/Fascia

Organ/Part of
Organ

Location/Description

Notes

tracheal

main airway that lies

anterior to the
esophagus

trachea extends from vertebral level C6 to the

level of the T4/5 intervertebral disc; superiorly it is
connected to the cricoid cartilage via the
cricotracheal ligament; it bifurcates into two
primary bronchi (Greek, trachys = rough, originally
the term for this structure was trachea arteria, the
rough artery)

carina

keel-shaped cartilage
lying within the
tracheal bifurcation

carina trachealis is an important landmark during

endoscopy of the bronchial tree (Latin, carina =
keel of a boat)

main (primary)
bronchus

pass inferolaterally
from the bifurcation of
the trachea at the
level of the sternal
angle to the hilum

the right main bronchus is wider, shorter and runs

more vertically than the left main bronchus; the
left main bronchus passes inferior to the arch of
the aorta and anterior to the esophagus and
thoracic aorta (Latin, bronchus = windpipe, from
the Greek brechein, to pour or moisten, from an
ancient belief that solids were conveyed to the
stomach by the esophagus and fluids by the
bronchi)

hilum

medial surface of the

lung

the point at which the structures forming the root the main bronchus, pulmonary vessels, bronchial
vessels, lymphatic vessels, and nerves - enter and
leave the lung

lung

the portion of the

respiratory system
where exchange of
gasses occurs between
the air and the blood;
located in the thoracic
cavity

paired; right lung is divided into three lobes:

superior, middle and inferior; left lung has two
lobes: superior and inferior

lobe, superior

the portion of the lung

supplied by the
superior lobar
bronchus

superior lobe of the right lung: possesses three

bronchopulmonary segments - apical, anterior and
posterior; superior lobe of the left lung: possesses
four bronchopulmonary segments - apicoposterior,
anterior, superior lingular, inferior lingular

lobar
(secondary)
bronchi

branches of the main

bronchus

two on the left; three on the right (Latin, bronchus

= windpipe, from the greek brechein, to pour or
moisten, from an ancient belief that solids were
conveyed to the stomach by the esophagus and
fluids by the bronchi)

apex of lung

the blunt superior

surface of the lung
projecting above the
level of the 1st rib into
the root of the neck;
covered by cervical
pleura

(Latin, apex = tip)

base of lung

the inferior surface of

the lung that contacts
the dome of the
diaphragm

also called the diaphragmatic surface

cardiac notch

indents the
anteroinferior aspect
of the superior lobe of
the left lung

creates the lingula, a tongue-like process of the

superior lobe

fissure, oblique

deep groove in the

surface of the lung
that separates the
upper lobe from the
lower lobe (both
lungs), and the middle
lobe from the lower
lobe (right lung)

oblique fissure extends from the level of the T3

vertebra posteriorly to the 6th costochondral
junction anteriorly

fissure,
horizontal)

deep groove in the

surface of the lung
that separates the
middle lobe from the
upper lobe (right lung
only)

horizontal fissure extends from the 5th rib at the

mid-axillary line along the 4th rib to the sternum
anteriorly

lingula

lower portion of
superior lobe of left
lung; below cardiac
notch

(Latin, lingula = little tongue)

lobe, inferior

the portion of the lung

supplied by the inferior
lobar bronchus

inferior lobe of the right lung: possesses 5

bronchopulmonary segments - superior, anterior
basal, posterior basal, medial basal, lateral basal;
inferior lobe of the left lung: possesses 5
bronchopulmonary segments - superior, anterior
basal, medial basal (may be fused into
anteromedial basal), posterior basal, lateral basal

lobe, middle

the portion of the right

lung supplied by the
middle lobar bronchus

middle lobe is found in the right lung only; it

possesses 2 bronchopulmonary segments: medial
and lateral; lingula of the inferior lobe of the left
lung is equivalent to the middle lobe of the right
lung

lingular
bronchus

bronchus branch
located in the lingula
of the left lung

(Latin, bronchus = windpipe, from the greek

brechein, to pour or moisten, from an ancient
belief that solids were conveyed to the stomach by
the esophagus and fluids by the bronchi)

segmental
(tertiary)
bronchi

branches of the lobar

bronchi

(Latin, bronchus = windpipe, from the greek

brechein, to pour or moisten, from an ancient
belief that solids were conveyed to the stomach by
the esophagus and fluids by the bronchi)

bronchopulmon
ary segments

branches of the
segmental bronchi

pyramidal-shaped segment of the lung, with its

apex facing the root and its base at the pleural
surface; these are the largest subdivisions of a
lobe, separated by septa, and are named
according to the segmental broncus supplying it

Clinical Terms

Term

Definition

bronchoscopy

an examination used for inspection of the interior of the tracheobronchial tree, performance of endobronchial diagnostic tests, taking of
specimens for biopsy and culture and removal of foreign bodies

pneumonectomy

an operation to remove an entire lung

chronic
obstructive
pulmonary
disease (COPD)

a progressive disease process that most commonly results from smoking

and mainly affects expiratory air flow. COPD includes chronic bronchitis
and emphysema. Obstructive pulmonary disease is characterized by
difficulty breathing, wheezing, and a chronic cough; treatment includes
absolute avoidance of smoking, bronchodilators and oxygen for those
with advanced disease; complications include bronchitis, pneumonia