Anatomy Reviewer: Superior, Anterior, Posterior

MS
Mediastinum:
- spaceinside thoracic artery found outside
Pleural cavity
- Devoid of contents
- smallest of all the compartments
- basically composed of fat or areolar tissue
And internal and internal thoracic vessels
- not much important structures found here
NOTE:
1. All the space outside within thoracic cavity
which is outside the pleural cavity will have
to be included in the mediastinum
2. All though mediastinum is not as big a
space as the pleural cavity , it is quite
extensive
BOUNDARIES:
Superior Mediastinum:
Thoracic Inlet (Superiorly)
Transverse line drawn from manubriosternal junction to the lower border of T4
(Inferiorly)
Inferior Mediastinum:
- below the line of the diaphragm
- below the manubrio-sternal junction

SUBDIVISIONS:
Anterior Mediastinum:
- anterior to pericardium and behind
sternum
Middle Mediastinum :
- Pericardium and heart
Posterior Mediastinum:
- behind pericardium up to the vertebral
column

SUPERIOR MEDIASTINUM:
Thymus
Superior vena cava
Innominate vein and artery
Arch of aorta
Pulmonary Arteries
Vagus nerves
Phrenic nerves
Trachea
Thymus:
- 2 lobes in children
- Production of T lymphocytes
- involutes after puberty (almost not
visible)
Arteries: Internal thoracic Artery
Veins: Drain left innominate vein
NOTE: All though thymus is in the sup. MS, its
lower part is seen in the anterior mediastinum. So

Superior Vena Cava:

- formed by the union of the right and
left
Brachiocephalic vein or innominate
vein
- 7 cm long
- from 1st rib and terminates at 3rd
costal
Costal cartilage
- upper half in superior mediastinum
- lower part is found in the pericardial
sac
or part of the middle mediastinum
- receives the azygous

TRIBUTARIES:
Azygous
Brachiocephalic
BOUNDARIES:
Anterior (margin of right lung and
pleura)
Posterior (root of right lung and
vagus)
Right (Phrenic and right pleura)
Left (beginning of brachiocephalic
Artery and
Ascending aorta)

Innominate Veins:
- union of the internal jugular and
subvlacian
Veins
- left is longer than right
(because superior vena cava is
slightly to the
Left of midline?)
- begins at the sternal end of the
clavicle to
Costal cartilage of the 1st rib (start
of Sup.
Vena Cava)

TRIBUTARIES OF RIGHT:
Right vertebral vein
Right internal thoracic vein
Right inferior thyroid vein
TRIBUTARIES OF LEFT:
Left vertebral vein
Left internal thoracic vein
Left inferior thyroid veins
Among these, it will also drain the left
superior intercostal vein (Drain to the
left brachiocephalic vein)

NOTE: There are anatomic variations to the

inferior thyroid veins. It is possible that the
right inferior thyroid will fuse with the left
inferior thyroid now forming a single vein to

Relations of the innominate vein:

BOUNDARIES:
Anteriorly related to:
(muscles of the larynx)
- sternohyoid
- sternothyroid
- remnants of thymus
Posteriorly related to
(branches of the arch of the
aorta)
- Innominate artery
- left common carotid
- left subclavian artery

Arch of the Aorta:

- cont. of the ascending aorta
(part of aorta which proceeds
towards left
Ventricle. When the heart contracts
and
Pumps blood out, the ascending
aorta will
Receive it first)
- runs saggital plane (not coronal,
meaning it
Runs antero-posterio)
- left pulmonary artery and left main
bronchus
Runs below it
- ends at T4 level approximately
demarcation
Between superior and inferior
mediastinum

Innominate Artery:
- largest most anterior branch of arch
of the
Aorta
- from 2nd costal cartilage, right runs
obliquely
To the right sterno-clavicular joint
where It
will bifurcate into right subclavian
and and
Right common carotid
NOTE: Name innominate because there was
no name for the artery. More appropriate to
call it now the brachiocephalic since it will
supply the head and neck and heart and
upper extremity

BOUNDARIES/RELATIONS:
Anterior:
- sternohyoid
- sternothyroid
- right innominate vein (in front)
- inferior thyroid vein
- thymus
Posterior
- trachea
Right:
- right innominate vein
-right phrenic nerve
- pleura
Left:
- thymus
- trachea
- left common carotid
- inferior thyroid vein

NOTE: at birth, the lungs will expand and the

pressure will drop in the lungs and cause
blood flow

Trachea:
- begins where the larynx will end
- cylindrical structure going towards
T4 and T5
- lined by several tracheal cartilages
- incomplete circle, C or U shaped
Cartilage
- complete in anterior
- incomplete in posterior (next to
esophagus)
- bifurcates at level of T4 T5 to
become left
And right primarybronchi
NOTE: R primary bronchus has wider
diameter, shorter length,more space and
more vertical than the left. Thus if there is
foreign body, more likelihood of passing
through right primary bronchus to the right
lung

Patent Ductus Arteriosus:

- heart sound gives off machinery
type of sound from systole to diastole

* Cricoid lower most part of the larynx

- demarcates lower most part of
Larynx

- will continue as the descending

aorta or the
Thoracic aorta located at the
posterior
Mediastinum
- Ligamentum arteriosum
(ligament that attaches the aorta to
the
Pulmonary artery) which is the
remnant of
The ductus arteriosus

BRANCHES:

NOTE: Trachea no longer seen in the inferior

mediastinum
POSTERIOR MEDIASTINUM:
Esophagus
Thoracic Aorta
Azygous Veins
Sympathetic trunk
Thoracic duct
Thoracic splanchnic nerves
Esophagus:
- Cylindrical muscular column
- continuation of the (d ko marinig sib
ea)
- continues to the level of T10,
approximately
Where there is an opening in the
diaphragm
Called the esophagus
- is only a conduit which will allow
food to pass
Though the esophagus
- made up of muscle and capable of
peristalsis
NOTE: Peristaltic movement of esophagus is
not necessary to propel food down the
esophagus and down to the stomach
Sphincter of esophagus:
- allows food into stomach
-Relaxation of muscle will cause in a
Diaphragmatic esophagus? Labo
nya
magsalita
NOTE: Sometimes peristalsis of esophagus
may also cause pain (Cardiac spasm)
NERVE SUPPLY:
Branches of vagus nerve
> Front/Left Vagus Nerve
> Behind/ Right vagus nerve
3 Normal Narrowings of the Esophagus:
1st: Phyto or pharyngeal? Constriction is first
at thelevel Of the cricopharyngeus
muscle
Cricopharyngeus muscle is part of
the inferior
Pharyngeal constrictor
Lower part of inferior pharyngeal
contrictor
Forms a sphincter around esophagus
* Prevents food from going into the
oropharynx
* Gastroesophageal sphincter:
- not an anatomical sphincter (cant
see it)
- just physiologic
2nd: level of arch of aorta

Significance of 3 Narrowings:
- WHAT THE F?
- Ask dr. bea kung ano un
Thoracic Aorta:
- located slightly to the left of
esophagus
- continuation of the arch of the aorta
at the
Level of T4
- visible entirely on left side of thorax
- almost not visible on right
(Significance is
That if there is penetrating trauma
to the
Back that will enter the left thorax
near
Vertebra it will have a higher
likelihood
Of injuring the aorta

BRANCHES:
Parietal Branch
- arteries that go to the wall of the
thorax
(posterior intercostal arteries)

NOTE: R and L posterior intercostal arteries

are all derivatives of the coraco branches of
the ascending or thoracic aorta with the
exemption of the 1st intercostal which comes
from the posto cervical trunk of subclavian.
Lower intercostals come from descending
aorta
Visceral Branch
- goes to the organs
* Pericardial branch
*Bronchial arteries
*Esophageal Arteries
Azygous system of veins:
- means by which blood can drain
from
Posterior thoracic wall and posterior
Abdominal wallback into the heart
- not only does it drain intercostal
vessels
But it also drains venous plexuses of
Veins meaning veins around
vertebral
Column and spinal cord will drain
into
Azygous system
- arises from ascending lumbar vein
and

Subcostal vein
Right Azygous
- drain the lower 3 or 4 post.
Intercostal veins

NOTE: Upper intercostal will drain to

accessory hemiazygous veins in the upper
part
NOTE: another importance of the azygous
system of veins is that it can serve as
collateral supply/ tribulation? In cases when
blood cannot pass to the portal vein to be
diverted into inferior vena cava
CASE:
When venous blood from the abdomen cant
pass into the IVC via the portal vein, the ASV
can serve as an alternate route (Ex. Cirrhosis
of the liver = Portal Hypertension = ASV
serve as collateral circulation)
Esophageal Plexus of Vein:
- one of the collateral circulations in
times of
In hepatic cirrhosis in portal
hypertension
- will open up and allow some blood
Portal vein to drain into azygous
vein back
To the heart
- the price of this is that azygous
veins will
Dilate and cause varicous veins =
Esophageal Varicous prone to
rupture
(usually seen in patients with
Cancer of the liver)
Sympathetic Chain of Ganglias:
Ganglias:
- found on sides of vertebral column
- rounded structures
- groups of nerve cell bodies
outsidethe CNS
- only CNS has nerve cell bodies
-( nerve cell fibers will proceed to
spinal cord
Are only axons? No nerve cell bodies
expt ganglia)
Thoracic Sympathetic Ganglia:
- connected to cervical and
abdominal ganglia
- each ganglia is very close to the
head of the
Corresponding rib, in fact close to
the costo
Vertebral joint at the back
- also related to thoracic splanchnic
nerves
Thoracic Splanchnic nerves:
- are inf. Bundles of nerves
- action is to give sympathetic
innervations
To the gastrointestinal tract or
organs below
Diaphragm but nerves are found on

Thoracic Duct:
- largest lymphatic vessel

neck)

- common pathway of all lymph fluid

(except lymph from right chest and
Right upper extremity, head and
- carries lymph back to circulation via

the
and

Junction bed? Bet internal jugular

Subclavian

- begins at dilatation below

diaphragm known
As the cisterna chily at the level of
the 1st and
2nd lumbar vertebra
- will ascend through same passage
way of
post.

Aorta (aortic hiatus) goes up to

Mediastinum to the right of aorta
(bet. Aorta and azygous vein)
-found on the right at lower third of
Mediastinum
- left side at middle third to upper

third

Of mediastinum
Aorta only found only left side that is why
left lung has a groove for aorta, but azygous
vein creates depression on right lung
Esophagous more visible on the right