superior and posterior mediastinum - md connect · netter, f.h. interactive atlas of human anatomy....

Superior and Posterior Mediastinum

Assoc. Prof. Jenny Hayes

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infringement, it is necessary to have regard to the criteria set out in Part 3, Division 3 of the

Act.

Objectives • The layout and contents of the superior and posterior

mediastinum • The course of the ascending aorta, arch of aorta, descending

thoracic aorta and the major branches of each • The origin, course and relations of the jugular, subclavian,

brachiocephalic veins and SVC (and be aware of the azygous system of veins)

• The course and major relationships of trachea, oesophagus, thoracic duct, vagus and phrenic nerves

Suggested pre-reading Gray’s Anatomy for Students: Regional anatomy of Superior and Posterior mediastinum, Chapter 3, Thorax, p. 204-223, 2nd ed. OR Clinicall y Orientated Anatomy, Moore: Superior mediastinum and great vessels, posterior mediastinum, Chapter 1, Thorax, p.160-170, 6th ed.

Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #186

Moore K L. Clinically Oriented Anatomy. 2nd ed. Williams and Wilkins; 1985. ISBN 0683061321. Ch.1 Page54


thymus great veins

↓ aortic arch vagus + phrenic nerves

↓

trachea oesophagus thoracic duct L recurrent laryngeal nerve

Superior mediastinum From superficial →deep


brachiocephalic veins

SVC

right atrium

IJV

subclavian vein

IVC

Netter, F.H.

Interactive Atlas of Human Anatomy. 3rd ed.

New Jersey, Icon Learning Systems, 2003,

ISBN: 1-929007-15-9, Plate #226A

Azygous vein

Central vein catheterization: http://www.youtube.com/watch?v=FXJvvSbgVTE http://www.youtube.com/watch?v=eLXN89AYCwE&NR=1 http://www.youtube.com/watch?v=w6y_BBQhGmc&feature=related

http://www.youtube.com/watch?v=FXJvvSbgVTE

http://www.youtube.com/watch?v=eLXN89AYCwE&NR=1


Arch of aorta

Left pulmonary artery

Left main bronchus

Pulmonary veins Descending

thoracic aorta


Ligamentum arteriosum

Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #182A

Brachiocephalic trunk

Right subclavian

Right common carotid Left common carotid

Left subclavian

Moore K L. Clinically Oriented Anatomy. 6th ed. Lippincott,Williams and Wilkins; 2010. ISBN 978-1-60547-652-0. Ch.1 Page 174


on scalenus anterior

b/w subclavian artery+vein

anterior to lung root

pierces diaphragm

C3,4,5 Phrenic nerve


Right phrenic nerve is lateral to venous structures: SVC,R atrium, IVC

Left phrenic nerve is lateral to arterial structures: Aortic arch and L ventricle


Motor supply to the diaphragm from its abdominal surface Sensory to mediastinal + diaphragmatic pleura + pericardium


Vagus nerve Cranial nerve Posterolateral to CCA


Alongside trachea ↓ Behind lung root ↓ Anterior oesophagus

R vagus nerve

Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.204


Lateral to aortic arch* *posterior to phrenic n *crossed by superior IC vein *gives of L recurrent laryngeal nerve ↓ Behind lung root ↓ Anterior oesophagus

phrenic nerve

superior IC vein

L recurrent laryngeal nerve

L vagus nerve

Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.198


Left of vertebral column

Approaching midline

Midline

Descending thoracic aorta


•Intercostal •Bronchial •Pericardial •Oesophageal

Branches of descending thoracic aorta

Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.198

Hansen,J.T. Netter’s Clinical Anatomy. 2nd ed. Elsevier, 2010, ISBN: 978-1-4377-0272-9, p.108

Relevant museum specimens displayed (beneath windows) Head & Neck Bay: • 516-100084 is a a dissection of the root of the neck and the superior

mediastinum. On the right side, part of the anterior wall of the thorax and some superficial muscles have been removed.

Thorax Bay: • 516-100208 is a dissection of the mediastinal contents showing the relations of

the trachea, the oesophagus, the thoracic duct and the left recurrent laryngeal nerve; the relations of the aortic arch and its branches to the vagus and phrenic nerves. In addition, it shows the relations of the great vessels to the pericardium and of the thyroid gland to the carotid sheath.

Images and information on these specimens can also be accessed via the museum

online database: http://mdhs.unimelb.edu.au/harrybrookesallenmuseum/catalogue An excellent pre-workshop and pre-dissection resource is Acland’s anatomy:

http://www.aclandanatomy.com.ezp.lib.unimelb.edu.au/

http://mdhs.unimelb.edu.au/harrybrookesallenmuseum/catalogue

http://www.aclandanatomy.com.ezp.lib.unimelb.edu.au/

superior and posterior mediastinum - md connect · netter, f.h. interactive atlas of human anatomy....

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