Lectures ON Mediastinum BY Dr. Paul A. Odey: (Bsc. MBBCH, Msc.,Lmih, Phd. in View)

LECTURES
ON
MEDIASTINUM
BY
DR. PAUL A. ODEY
(BSc. MBBCH, MSc.,LMIH, PhD. IN VIEW)
OUTLINE
 INTRODUCTION
 BOUNDARIES
 SUBDIVISIONS AND THEIR BOUNDARIES
 CONTENTS
 APPLIED ANATOMY
INTRODUCTION
 The mediastinum or mediastinal cavity is an area found in the
midline of the thoracic cavity, that is surrounded by the left
and right pleural sacs.
 The mediastinal cavity, is a visceral compartment of the

thoracic cavity.
 It completely separates the two pleural cavities by being

placed longitudinally between them in a median sagittal
position.
 It is divided into the superior and inferior mediastinum.
 The inferior mediastinum mediastinum.
 is further divided into the anterior, middle and posterior
 Every compartment of the mediastinum contains many vital
organs, vascular and neural structures that are closely related
one to another.
 Such a rich content of the mediastinum indicates its
significance from the aspect of the anatomy.
BOUNDARIES
 Superoinferiorly: From the superior thoracic
aperture to the diaphragm.
 Anteroposteriorly: From the sternum to the bodies

of thoracic vertebrae.
 Laterally: From the mediastinal pleura of the

adjacent pleural cavities.
BOUNDARIES OF THE SUPERIOR
MEDIASTINUM
 ANTERIORLY: By the posterior aspect of the manubrium of the
sternum.
 POSTERIORLY: By the anterior aspect of the bodies of T1-T4
vertebrae.
 SUPERIORLY: Bordered by an oblique plane extending from the
jugular notch of the manubrium to the superior border of T1
vertebra.
 INFERIORLY: bordered by a transverse plane extending from the
sternal angle to the T4-T5 intervertebral disc.
 LATERALY: Borders are the mediastinal surfaces of parietal
pleura on each side.
BOUNDARIES OF THE INFERIOR
MEDIASTINUM
 It extends from the inferior border of the superior mediastinum
superiorly to the diaphragm inferiorly.
 Anteriorly by the posterior aspect of the body of the sternum

 Posteriorly by the anterior aspect of T5-T12 vertebrae.
 Laterally by the corresponding pleura on either sides
 It is subdivided anterior-to-posterior into three spaces:

BOUNDARIES OF THE ANTERIOR
MEDIASTINUM
 ANTERIORLY: Posterior to the body of the
sternum.
 POSTERIORLY: Anterior to the pericardium

BOUNDARIES OF THE MIDDLE
MEDIASTINUM
 ANTERIORLY: Bounded by the anterior aspect of
the pericardium
 POSTERIORLY: Bounded by the posterior aspect of

the pericardium
 The pericardium encloses the heart and origins of

the great vessels
BOUNDARIES OF THE POSTERIOR
MEDIASTINUM
 ANTERIORLY: Posterior aspect of the pericardium.
 POSTERIORLY: By the anterior aspect of the

vertebrae T5-T12
CONTENTS OF THE SUPERIOR
MEDIASTINUM
 Thymus
 Trachea
 Esophagus
 Thoracic duct
 Aortic arch
 Veins (superior vena cava, brachiocephalic, left
superior intercostal)
 Nerves (vagus, phrenic, left recurrent laryngeal)
 Lymphatics, other small arteries and veins.
CONTENTS OF THE ANTERIOR
MEDIASTINUM
 Remnants of the thymus,

 Lymph nodes
 Inferior portion of thymus
 Fat
 Connective tissue
 Mediastinal branches of internal thoracic vessels
 Sternopericardial ligaments
CONTENTS OF THE MIDDLE
MEDIASTINUM
 Phrenic Nerve
 Heart,
 Pericardium,
 Ascending aorta,
 Pulmonary trunK,
 Superior vena cava,
 Pericardiacophrenic artery
CONTENTS OF THE POSTERIOR MEDIASTINUM
 Descending thoracic aorta
 Azygos veins
 Hemiazygos veins
 Accessory hemiazygos veins
 Thoracic duct
 Cisterna chyli
 Esophagus
 Esophageal plexus
 Vagus nerve
 Greater, Lesser and least splanchnic nerves
 Lymphatics
APPLIED ANATOMY OF THE
MEDIASTINUM
 Mediastinitis is inflammation or infection in the part of your
chest that contains your heart. It can be either acute (sudden)
or chronic.
 Acute mediastinitis is usually due to complications from a

median sternotomy or an esophageal tear.
 Symptoms include chest pain, fever and trouble breathing.
 Early treatment improves your chances of survival.

MEDIASTINAL SHIFT
 It is the deviation of the mediastinal structures towards
one side of the chest cavity, usually seen on chest
radiograph.
 It indicates a severe asymmetry of intrathoracic pressures.
 Mediastinal shift may be caused by volume expansion on
one side of the thorax, volume loss on one side of the
thorax, mediastinal masses and vertebral or chest wall
abnormalities.
 An emergent condition classically presenting with
mediastinal shift is tension pneumothorax.
 It is also a useful indicator of malignant pleural effusion.
 Mediastinal shift may be detected on antenatal ultrasound
in certain fetal conditions.
MEDIASTINAL SYNDROME
 Compression of mediastinal structures by any mass gives rise
to a group of the symtomes are associated with the anatomic
structures involved known as mediastinal syndrome.
 Superior mediastinal syndrome involves obstruction of

airways (trachea, main bronchi in particular) and/or cardiac
or great thoracic vessel compression, usually from a
mediastinal mass and represents a medical emergency.
 The compression of the trachea results in dyspnea and

respiratory insufficiency, whereas compression of the
esophagus results in dysphagia.
THANK YOU FOR
LISTENING

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LECTURES

 The mediastinal cavity, is a visceral compartment of the

 It completely separates the two pleural cavities by being

 Anteroposteriorly: From the sternum to the bodies

 Laterally: From the mediastinal pleura of the

 Anteriorly by the posterior aspect of the body of the sternum

 Laterally by the corresponding pleura on either sides

 It is subdivided anterior-to-posterior into three spaces:

 POSTERIORLY: Anterior to the pericardium

 POSTERIORLY: Bounded by the posterior aspect of

 The pericardium encloses the heart and origins of

 POSTERIORLY: By the anterior aspect of the

 Remnants of the thymus,

 Acute mediastinitis is usually due to complications from a

 Symptoms include chest pain, fever and trouble breathing.

 Early treatment improves your chances of survival.

 Superior mediastinal syndrome involves obstruction of

 The compression of the trachea results in dyspnea and

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