MEDIASTINUM

LEARNING OBJECTIVES
• What is mediastinum?
• Boundaries of mediastinum
• Divisions of mediastinum
• Contents of each division
• Related clinicals
WHAT IS MEDIASTINUM?
• It is middle space left in thoracic cavity in b/w
lungs
• It is median septum of thorax b/w two lungs
• It is thick moveable partition b/w lungs
surrounded by mediastinal pleura on each side
• It contains all the thoracic viscera except lungs
• Major structures in mediatinum are surrounded
by fat, lymphatics, nerves and vessels
 BOUNDARIES
• Anterior: sternum

• Posterior: vertebral column

• Superior: thoracic inlet

• Inferior: diaphragm

Snells Anatomy Page : 61

 DIVISIONS OF MEDIASTINUM
• Mediastinum is divided into
superior and inferior parts by an
imaginary line which passes
through the sternal angle
anteriorly to the lower body of
4th thoracic vertebra posteriorly

• Inferior mediastinum is further

divided by the pericardium into
anterior mediastinum, middle
mediastinum and posterior
mediastinum.
DIVISIONS
 SUPERIOR MEDIASTINUM
• It is present above the imaginary
line
• Bounded anteriorly by
manubrium sterni
• Posteriorly by upper four
thoracic vertebrae
• It contains trachea,
oesophagus, thoracic duct,
thymus, large arteries, large
veins, nerves and lymph nodes
 INFERIOR MEDIASTINUM

• It is present below the imaginary line

• Bounded anteriorly by body of sternum
and posteriorly by lower 8 thoracic
vertebrae
• Divided into
• anterior,
• middle,
• posterior parts
 ANTERIOR MEDIASTINUM
• It is narrow space present infront
of the pericardium.
• Bounded anteriorly by body of
sternum and posteriorly by
pericardium.
• It contains
• sternopericardial ligaments,
lymph nodes,
• small branches of internal
thoracic artery
• and areolar tissue.
 MIDDLE MEDIASTINUM
• It is bounded anteriorly by
sternopericardial ligaments an
posteriorly by oesophagus,
azygous vein and descending
thoracic aorta
• It contains heart enclosed in
pericardium, arteries
(ascending aorta, pulmonary
trunk and pulmonary
arteries)
• Veins ( pulmonary veins,
lower half of superior vena
cava)
 POSTERIOR MEDIASTINUM
• It is present behind the pericardium
• Bounded anteriorly by pericardium
and posteriorly by lower eight
thoracic vertebrae
• It contains
• oesophagus,
• arteries ( descending thoracic
aorta) ,
• veins ( azygous vein),
• nerves,
• lymph nodes ,
• lymphatics and
• thoracic duct
 CLINICALS
• Mediastinitis: any infection of deep fascia of neck can travel
to superior mediastinum and through it to posterior
mediastinum causing mediastinitis
• Mediastinal tumors or cysts : any tumor in mediastinum
compresses the relavent structure producing symptoms like
obstruction of SVC gives rise to engorgment of veins in
upper half of body, pressure over trachea causes cough and
dyspnea, other pressure effects can be seen on phrenic
nerve and sympathetic trunks
• Mediastinoscopy: diagnostic procedure to obtain
specimens of tracheo bronchial nodes without opening
pleural cavities. Procedure is used to determine the
diagnosis and spread of carcinoma of the bronchus.