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Thoracic cavity & mediastinum

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Basics of thoracic cavity & mediastinum for medical & nursing students

Published in: Health & Medicine

Thoracic cavity & mediastinum

  1. 1. 1 www.slideshare.net
  2. 2. 2
  3. 3. Thorax - boundaries 3
  4. 4. Plane of Inlet 4 45°
  5. 5. Superior Thoracic Aperture 5
  6. 6. Suprapleural membrane/ Sibson’s fascia 6
  7. 7. 7 Suprapleural membrane: Relations
  8. 8. Inf thoracic aperture-Diaphragm- ant view 8
  9. 9. 9 Layers in thoracic wall
  10. 10. Thoracic cavity 11
  11. 11. Pleura: Layers 1. Visceral 2.Parietal • Cervical • Costal • Diaphragmatic • Mediastinal 12
  12. 12. Parietal pleura 13
  13. 13. Pleura: Parts 14
  14. 14. PLEURAL REFLECTIONS 15
  15. 15. Surface marking 16
  16. 16. 17 Surface marking
  17. 17. Pulmonary ligament 18
  18. 18. Pleural recesses 19
  19. 19. Nerve supply of Pleura  Parietal pleura - somatic nerves - Intercostal & phrenic nerve - pain sensitive  Visceral pleura - autonomic nerves - (T2 to T5) & vagus - pain insensitive 20
  20. 20. Mediastinum 21
  21. 21. 22 Mediastinum: Boundaries & SUBDIVISIONS
  22. 22. Superior Mediastinum: Boundaries 23 • Ant: Manubrium sterni • Post: T-1 to T-4 • Sides: Mediastinal pleura • Sup: Plane of thoracic inlet • Inf: Imaginary line joining sternal angle and lower border T-4
  23. 23. Superior Mediastinum - contents 24
  24. 24. Superior Mediastinum: Contents • Muscles: •Sternohyoid •Sternothyroid •Longus colli • Thymus: in childhood & puberty • Trachea & Esophagus • Thoracic Duct 25
  25. 25. • Veins • SVC • Lt & Rt brachiocephalic veins • Supreme intercostal veins • Lt Superior Intercostal vein • Arteries: • Arch of Aorta • Brachiocephalic artery • Lt Common carotid • Lt subclavian artery 26
  26. 26. 27
  27. 27. Anterior Mediastinum: Contents • Thymus (Children) • Sternopericardial ligaments • Internal thoracic artery & branches • Lymphatics & Lymph nodes 28
  28. 28. Middle Mediastinum: Contents cont. Heart enclosed in pericardium Arteries: Ascending Aorta, Pulmonary trunk with its branches Veins: SVC, Termination of Azygos, Pulmonary veins 29
  29. 29. • Nerves: Phrenic, Deep cardiac plexus • Bifurcation of Trachea with two principal bronchi • Tracheobronchial lymph nodes 30
  30. 30. 31 Posterior Mediastinum Contents
  31. 31. Posterior Mediastinum: Contents • Esophagus • Thoracic duct • Arteries : Descending Aorta with its brs • Veins: Azygos, Hemiazygos & Accessory hemiazygos • Nerves: Vagus & Splanchnic nerves • Lymph nodes: Posterior mediastinal32
  32. 32. Applied Anatomy • Pleuritis/pleurisy • Pleural effusion / hydrothorax • Haemothorax • Empyema • Referred pain - from diaphragmatic pleura • Pleural tapping • Pneumothorax – open, closed, tension 33
  33. 33. Tension Pneumothorax • Distended neck veins • Tracheal shift • Decreased breath sounds • Hyper resonance (involved hemithorax) • Collapsed lung on same side • Medical emergency • Tt : Needle decompression 2nd ICS in MCL 34
  34. 34. Needle decompression 2nd ICS in MCLNeedle decompression 2nd ICS in MCL 35
  35. 35. Applied AnatomyApplied Anatomy • Mediastinitis • Mediastinoscopy 36
  36. 36. 37 Mediastinoscopy
  37. 37. Mediastinoscopy • Intro: Visualization of mediastinum +- biopsy • Indications: – Staging of lymph nodes of lung cancer – Diagnose sarcoidosis or lymphoma. • Procedure: – Incision 1 cm above the suprasternal notch – Dissection in pretracheal space upto carina. – Mediastinoscope advanced into the created tunnel – View of the mediastinum 38
  38. 38. • Superior Mediastinal syndrome obstruction to SVC •Engorgement of veins •Dyspnea •Dysphagia •Hoarseness of voice • Mediastinal shift 39
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