Thorax anatomy

Lecture 12
Mediastinum (part 2)
• Thymus
• Brachiocephalic veins & SVC
SCV
• Ascending aorta
• Arch of aorta & its branches
• Descending aorta & its branches
• Pulmonary trunk & pulmonary arteries
Sajjad Abdulaziz
A 3rd-staged medical student at Al-Nahrain • Ligamentum arteriosum
University

Thymus
🔵 The thymus is :
- a primary lymphoid organ .
- a flat gland with flask-shaped lobes .
- located in the anterior part of the superior mediastinum (just posterior
to the manubrium) and may extend up into the neck or down in the
anterior mediastinum .
🔵 Regarding the size of the thymus :
- at birth, relative to the adjacent structures, it appears as its largest .
- it reaches it is largest size just before puberty .
- after puberty, it is gradually replaced by fat .
🔵 Supplied by branches of the internal thoracic arteries .
🔵 Drained by veins that end in the left brachiocephalic, internal thoracic
& inferior thyroid veins .
🔵 The lymphatic vessels of the thymus end in the parasternal,
brachiocephalic and tracheobronchial lymph nodes .

Internal thoracic arteries

Internal thoracic veins

Brachiocephalic veins
🔵 Posterior to the sternoclavicular
(SC) joints, the internal jugular
veins and subclavian veins unite to
form the right & left
brachiocephalic veins . Left subclavian vein

🔵 These large veins lie in the

superior mediastinum .
🔵 At the level of the inferior border
of the right 1st costal cartilage, the
right and left brachiocephalic veins
unite to form the SVC .
🔵 The left brachiocephalic vein is
longer than the right one, because
it passes from the left to the right
side, anterior to the roots of the
three major branches of the arch of
the aorta .

Superior vena cava (SVC)

🔵 At the level of the inferior border of
the right 1st costal cartilage, the right
and left brachiocephalic veins unite to
form the SVC .
🔵 It passes inferiorly .
🔵 At the level of the right 2nd costal
cartilage (level of sternal angle), the
SVC receives the arch of azygos vein
posteriorly .
🔵 At the level of the right 3rd costal
cartilage, the SVC ends in the right
atrium of the heart.
🔵 The SVC is divided into two halfs :
- upper (extrapericardial) half : lies in the superior mediastinum .
- lower (intrapericardial) half : lies in the middle mediastinum .

Ascending aorta
🔵 The ascending aorta is the intrapericardial segment of the aorta .
🔵 lies in the middle mediastinum .
🔵 The ascending aorta :
- begins at the aortic orifice .
- ascends up .
- ends at the level of sternal angle by
becoming the arch of the aorta .
🔵 The only branches of ascending
aorta are the coronary arteries .

Right & left coronary arteries

Arch of the aorta

🔵 The arch of aorta (aortic arch) :
- begins posterior to the right 2nd sternocostal joint (level of the sternal
angle) as continuation of the ascending
aorta .
- arches superiorly, posteriorly and to
the left and then inferiorly.
- ends posterior to the left 2nd
sternocostal joint (level of the sternal
angle) by becoming the thoracic aorta .
🔵 The arch of aorta :
- ascends anterior to the right pulmonary
artery and bifurcation of the trachea .
- reaches its apex left to the trachea and
esophagus as it passes over root of the
left lung, then posterior to it .

Branches of arch of the aorta :

1) The brachiocephalic trunk :
- is the first and largest branch of
the arch of aorta .
- ascends superolaterally posterior
to the left brachiocephalic vein and
anterior to then on the right side of
the trachea .
- reaches the right SC joint, where it
divides into the right common
carotid and right subclavian
arteries .

2) The left common carotid artery :

- is the second branch of the arch of aorta .
- arises posterior and to the left of the brachiocephalic trunk .
- ascends superolaterally posterior to
the left brachiocephalic vein and
anterior to then on the left side of
the trachea .
- enters the neck by passing
posterior to the left SC joint .

3) The left subclavian artery :

- is the third branch of the arch of aorta .
- arises posterior to the left common carotid artery .
- ascends superolaterally posterior
to the left brachiocephalic vein and
lateral to the trachea and left
common carotid artery .
- enters the neck by passing
posterior to the left SC joint .

Thoracic aorta
🔵 Thoracic aorta (part of descending
aorta) :
- begins on the left side of the T4-T5 IV
disk as continuation of the arch of
aorta .
- descends in the posterior mediastinum
posterior to the esophagus and
left to then anterior to the bodies
of T5-T12 vertebrae .
- passes through the aortic hiatus
in the diaphragm (anterior to
the body of T12 vertebra) and
enters the abdominal cavity (with
a name change to abdominal
aorta) .

🔵 Branches of thoracic aorta are :

- 2-5 esophageal arteries .
- bronchial arteries .
- 3rd-11th posterior intercostal
arteries .
- subcostal arteries .
- superior phrenic arteries :
anastomose with the
musculophrenic and
pericardiacophrenic branches
of the internal thoracic artery .
- pericardial branches
- small mediastinal arteries .

Pulmonary trunk
🔵 The pulmonary trunk is an intrapericardial structure .
🔵 lies in the middle mediastinum .
🔵 The pulmonary trunk :
- begins at the pulmonary orifice .
- ascends up .
- bifurcates at the level of sternal angle
by dividing into right & left
pulmonary arteries .

Pulmonary arteries
🔵 The right pulmonary artery goes to the
right lung, passing :
- in front of right main bronchus
and the esophagus .
- behind the ascending aorta and
SVC .
🔵 The left pulmonary artery goes to the
left lung, passing in front of left main
bronchus and the descening aorta .

Ligamentum arteriosum
🔵 Connects the beginning of the left pulmonary artery to the inferior
surface of the arch of the aorta .
🔵 Is the remnant of the fetal ductus arteriosus (that short-circuited the
functionless lungs by diverging most of the right ventricular outflow into
the aorta) .

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