MEDIASTINUM and its CONTENTS

ROLL No. 20 055

 A
Mediastinum :

It is a movable partition in the median thoracic cavity, MEDIASTINUM

housing certain organs and structures of thorax.
- made up of loose connective tissue.

Location : Between the two medial pleura of the

laterally positioned lungs.
HORIZONTAL EXTENT

Extent:

^ horizontally : from sternum to bodies of vertebra

^ vertically : from superior thoracic* aperture to
VERTICAL EXTENT
diaphragm.

Function: Serves as a passageway for structures like

B C
oesophagus, thoracic duct, nerves and vessels.

( develops from embryonic mesenchyme*.)

*
*Thoracic aperture : T1 + u.m. of sternum + 1st rib

* Embryonic mesenchyme : @neural crest (ectoderm) giving rise to

most of connective tissue layers.
BOUNDARIES:
SUPERIOR
Anteriorly : Sternum
Superiorly : Thoracic inlet
Posteriorly : Vertebral column ( T1 – T12 )
Inferiorly : Diaphragm ANTERIOR
Lateral walls : Mediastinal pleura POSTERIOR
MIDDLE

The mediastinum is divided into 4 compartments;

A
- superior, inferior ( anterior, posterior, and middle ).

The superior mediastinum is separated from the other compartments by

an imaginary line drawn from the sternal angle* to the base of T4
vertebra.

The inferior mediastinum, is divided into 3 compartments ( anterior,

middle, and posterior ) by the pericardial sac* enclosing the heart.
B
*sternal angle : adjoining point of
the manubrium and
body of sternum.
*pericardial sac: sac of fibro-serous
tissue enclosing
the heart.
 SUPERIOR MEDIASTINUM
BOUNDARIES:
Anterior : manubrium sterni
Posterior : T1 – T4
Superior : plane of thoracic inlet
Inferior : imaginary line ^ from sternal angle to A
base of T4 ^
Lateral : mediastinal pleura on each sides

CONTENTS :

Thymus,
Trachea,
Esophagus,
Muscles (origins of sternohyoid, sternothyroid, and l.e.
B
of longus coli)
Thoracic duct,
Aortic arch,
Veins ( sup. Vena Cava, brachiocephalic, left superior
intercostal ),
Nerves (vagus, phrenic, left recurrent laryngeal),
Lymphatics, Small arteries and veins.

PNEMONICS (nutrition),
“Try To Eat Meat, Toast And Vitamins Lawm
Sangzual”
C
 ANTERIOR (ANTERO-INFERIOR) MEDIASTINUM

BOUNDARIES:

Anterior : Body of sternum

Posterior: Pericardium
Superior : Imaginary plane ^ from sternal angle to T4^
A
Inferior : Superior surface of diaphragm
Lateral : Mediastinal pleura on each side
A-I Med.

CONTENTS:

Sterno pericardial ligaments,

Lymph nodes with lymphatics,
mediastinal branch of Int. thoracic artery,
Thymus ( only remnants in adult),
Areolar tissues.

B
Pnemonics (nutrition),

“Some Likes Ice Tea Alone”

 MIDDLE MEDIASTINUM

BOUNDARIES : A
Anterior : sterno pericardial ligaments
Posterior : oesophagus, descending thoracic aorta, azy-
gous vein.
Lataeral : mediastinal pleura

CONTENTS:

Heart with its covering pericardium,

Arteries ( a.aorta, p.trunk, 2 p.areteries),
Veins ( lowers ½ of sup. V.C. , terminal part of azygous vein,
right and left p. veins ),
Phrenic nerve + deep cardiac plexus,
Tracheobronchial lymph nodes, All the prominent vessels
Bifurcation of trachea, right and left principal bronchi.
that goes in and out of
the heart are in the
middle mediastinum.
 POSTERIOR MEDIASTINUM

BOUNDARIES:

Anterior : Pericardium, bifurcation of trachea/carina,

pulmonary vessels, posterior diaphragm.
Posterior : T1 – T12 + intervening cartilaginous discs.
Lateral : Mediastinal pleura.
Superior : Line joining sternal^ and base of T4. A
Inferiors : Ends in the meeting point of diaphragm and
T12.

B
CONTENTS:
B
Oesophagus,
Arteries : descending thoracic aorta + it branches,
Veins : azygous, hemiazygous, accessory hemiazygous,
Nerves : vagus nerve, spanchnic nerve ( greater + lesser
+ least )
Lymphatics : posterior mediastinal, thoracic duct.
ESOPHAGUS
CLINICAL ASPECTS

A. X-RAY SHOWING THORACIC INFECTION

B. POSTSTERNOTOMY

MEDIASTINITIS : spreading of infection in neck into thorax ( mediastinum is in continuation with the neck )

COMPLICATIONS : subcutaneous emphysema (in case of esophageal perforations), pericarditis.

SYMPTOMS : swelling in neck, fever, pleuritic + retrosternal chest pain.

TREATMENT : antibiotics in mild conditions, surgical operations.

CLINICAL ASPECTS

MEDIASTINAL CYST/TUMOR MEDIASTINAL DEFELCTION MEDIASTINOSCOPY

- Tumour of left lung can ra- - In case of pneumothorax, - Procedure for determining
pidly spread to mediastin- lung may collapse and the diagnosis and degree
al lymph nodes. mediastinum is displaced. of spread of carcinoma on
bronchus.

- Complication : - Symptoms : breathlessness

and state of shock. - Small incision is made the
* growth of tumour can midline of neck just above
compress left recurrent the suprasternal notch.
laryngeal nerve causing - Clinical finding : heart and
paralysis of left vocal trachea displaced to opp-
cord. osite side.
* occlusion of veins of
upper body, sympathetic
trunks, phrenic nerves,
trachea, main bronchi .

- Symptoms collectively call

mediastinal syndrome.
CLINICAL ASPECTS

ENGORGED VEINS AROUND NECK AND CHEST

MEDIASTINAL SYNDROME BRONCHO-MEDIASTINAL LYMPH NODES

- Engorgement of veins due to obstruction

of sup. V.C. - Connection with parasternal lymph nodes
- dyspnea, due to pressure over trachea
- Dysphagia, due to pressure on oesophagus. - Carcinoma from mammary gland
- Intercostal neuralgia, pressure on intercostal nerves. sometimes metastasize through it.
- Erosion of vertebral bodies.
- Dysphonia, due to compression of
left laryngeal nerve.
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