THORACIC CAVITY

MEDIASTINUM

Mediastinum
Mediastinum

= space between lungs. Superior mediastinum:

Separated from inferior by horizontal plane between sternal angle and IV disc T4-T5.
Fig.

1.34, p 135.

Mediastinum
Inferior:

Anterior: Middle: Posterior:

Superior Mediastinum
Retrosternal:

Great vessels and branches. Thymus.

Prevertebral:

Trachea Esophagus Thoracic duct Sympathetic trunks Vagus nerves

Inferior Mediastinum
Anterior:

Thymus, fat, lymph nodes

Middle:

Pericardium Phrenic nerves Pericardiacophrenic artery Heart and great vessels

Inferior Mediastinum
Posterior:

Esophagus Thoracic duct Aorta and branches Vagus nerves Sympathetic trunks Azygos system of veins

SUPERIOR MEDIASTINUM

Thymus
Occupies

superior mediastinum on either side of the midline. Behind manubrium. Covered by converging pleura of the lungs. Involutes with fat after puberty.

Thymus
Blood

supply:

Anterior mediastinal arteries from internal thoracic artery. Inferior thyroid arteries from subclavian

artery. Venous drainage:

Into left brachiocephalic vein.

Thymus
Innervation:

Vagus nerve. Cardiac sympathetic plexus.

Middle Mediastinum (inferior)

Pericardium:

Encloses heart. (Fig. 1.35, p 137).

Middle Mediastinum (inferior)

Pericardium:

Visceral (serous) (Fig 1.37, p 139):

= epicardium. Arterial mesocardium. Venous mesocardium. Transverse sinus:
Space between arterial and venous mesocardium.

Oblique sinus:
Space between right and left pulmonary veins.

Middle Mediastinum (inferior)

Pericardium:

Pericardial cavity. Parietal (serous):

Fused to fibrous pericardium.

Fibrous:
Fused with central tendon of diaphragm:
Pericardiacophrenic ligament.

Fused with sternum:

Superior and inferior sternopericardial ligaments.

Middle Mediastinum (inferior)

Pericardium:

Blood supply (Fig. 1.38, p 139):

Pericardial arteries. Pericardiacophrenic arteries. Musculophrenic arteries.

Nerve supply:
CN X. Phrenic nerve. Sympathetic trunk.

POSTERIOR MEDIASTINUM

Esophagus
From

base of neck to:

Left of midline to: Midline to: Left of midline.

Passes Lies:

through diaphragm at level of T10.

Behind trachea. In front of vertebral column.

Esophagus Blood Supply

Bronchial

artery. Thoracic aorta. Left gastric artery. Left inferior phrenic artery.

Esophagus Innervation
Esophageal

plexus:

Continuation of posterior pulmonary plexus. Formed by right and left vagus nerves:
Right vagus nerve posterior vagus nerve. Left vagus nerve anterior vagus nerve.

Esophagus Innervation
Upper

third:

Voluntary muscle. Innervated by recurrent laryngeal nerve.

Lower

two-thirds:

Involuntary muscle. Innervated by vagus and sympathetic chain.

Left Thoracic duct

Arises

from cisterna chyli: on the front of vertebral body T-12

At union of right and left lumbar trunks.

Begins

or L-1. Runs up through the thorax along the front of the vertebral column. At first it lies to the right of midline.

Left Thoracic duct

It

moves over to the left side when it reaches level T-5. Receives most of lymph from body below diaphragm. Drains left side of thoracic cavity and part of right.

Left Thoracic duct

Receives

lymph from left internal jugular lymph trunk. Receives lymph from left subclavian lymph trunk. Empties into venous system at junction of:
Left internal jugular vein. Left subclavian vein.

Right Thoracic duct

Drains

upper right thoracic cavity, right upper extremity, and right side of head and neck. Empties into venous system at junction of:
Right internal jugular vein. Right subclavian vein.

Thoracic Sympathetic Chain

Lies

against neck of ribs and costovertebral junctions. 12 thoracic ganglia pairs:

First one often fused with inferior cervical ganglion:
Referred to as stellate ganglion collectively.

Thoracic Sympathetic Chain

Cervical

ganglia:

Superior. Middle. Inferior.

Thoracic Sympathetic Chain

The

preganglionic sympathetic supply to the thoracic viscera are from T15. The postganglionics are from:
Superior, middle, and inferior cervical ganglia. T1-T5 paravertebral ganglia.
They

exit the chain as direct fibers and travel downwards to enter the thorax:
As cardiopulmonary splanchnic nerves.

Thoracic Sympathetic Chain

The

cardiopulmonary splanchnic nerves travel on their own and do not accompany other nerves or vessels. Function:
Coronary artery dilation. Increase heart rate. Bronchodilation.

Splanchnic Nerves
Composed

of preganglionic fibers and visceral sensory fibers. Supply abdominal viscera. Synapse in prevertebral ganglia. Refer in text to Figure 1.41, page 63.

Splanchnic Nerves
Greater:

T5-T9. Synapses in celiac ganglion.

Lesser:

T10-T11. Synapses in the superior mesenteric ganglion.

Splanchnic Nerves
Least:

T12. Synapses in the aorticorenal ganglion.

Vagus Nerve
Cranial

nerve X Major parasympathetic supply to thoracic and abdominal viscera.

Course of Vagus Nerve

Parallel Passes

to esophagus: posterior to root of lung on each

Innervates esophagus

side. Pierces diaphragm with esophagus. Becomes gastric nerve. Supplies viscera in thoracic cavity.

Vagus Nerve Branches

Cardiac

branches to cardiac plexus. Pulmonary branches to pulmonary plexus. Esophageal branches to esophageal plexus.

Vagus Nerve Branches

Left

recurrent laryngeal nerve from left vagus:

Hooks around arc of aorta to left of ligamentum arteriosum.

Right

recurrent laryngeal nerve from right vagus:

Hooks around subclavian artery. Therefore: arises in neck, not thorax.

Phrenic Nerve
Arises

in neck from:

Ventral rami of C3-5 (C4 = major contribution)

Passes

anterior to pulmonary root on each side (only nerve to do so). Sole motor innervation to diaphragm. Sensory fibers to pericardium, mediastinal pleura, and pleural and peritoneal coverings of diaphragm.

Phrenic Nerve
Pain

via phrenic nerves usually referred to base of neck and tip of shoulder. Accompanied by pericardiacophrenic arteries.
Branches of internal thoracic arteries

Lymphatic Drainage
50

tracheobronchial lymph nodes :

Some of the largest lymph nodes in the body. Include:

Paratracheal Superior tracheobronchial Inferior tracheobroncial Bronchopulmonary Pulmonary

Text: p 131, Fig. 1.32

Lymph Drainage of Thoracic Cavity

Parasternal

nodes:

Lie behind sternum along course of internal thoracic artery. Receive lymph from thoracic wall, upper anterior abdominal wall, and diaphragm. Also receive significant amount of lymph from mammary gland. Dump into parasternal lymph channel.

Lymph Drainage of Thoracic Cavity

Posterior

intercostal nodes:

Lie in posterior intercostal space between heads of ribs. Receive lymph from thoracic wall and paravertebral regions. Drain into thoracic duct:
From left and lower right.

Drain into right lymphatic duct:

From upper right.

Lymph Drainage of Thoracic Cavity

Diaphragmatic

nodes:

Lie on upper surface of diaphragm. Receive lymph from diaphragm, pericardium, upper surface of liver. Drain to parasternal and posterior mediastinal nodes.

Lymph Drainage of Thoracic Cavity

Posterior

mediastinal nodes:

Lie along esophagus and descending thoracic aorta.

Brachiocephalic

nodes:

Lie along brachiocephalic veins.

Lymphatic Drainage of Thorax

Lymph

Trunks

Bronchiomediastinal lymph trunks receive lymph from:

Posterior mediastinal nodes Brachiocephalic nodes Tracheobronchial nodes Parasternal nodes

Lymphatic Drainage of Thorax

Thoracic

Duct

Begins in abdomen on right side of midline. Receives most of lymph from body below diaphragm. Drains left side of thoracic cavity and part of right. Receives lymph from left internal jugular lymph trunk.

Lymphatic Drainage of Thorax

Thoracic

Duct (cont.):

Receives lymph from left subclavian lymph trunk. Empties into venous system at junction of:
Left internal jugular vein. Left subclavian vein.

Lymphatic Drainage of Thorax

Right

Lymphatic Duct:

Drains upper right thoracic cavity, right upper extremity, and right side of head and neck. Empties into venous system at junction of:
Right internal jugular vein. Right subclavian vein.