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TBL reading resource The mediastinum – Anterior and Middle The student should be able to;  list structures

found in the Anterior and Middle mediastinum, and briefly be aware of their spatial relationships.  describe the arrangement of the chambers of the heart, and its surfaces and borders (including apex and base and sulci)  describe the fibrous pericardium and the parietal and visceral layers of the serous pericardium.

The thorax includes the primary organs of the respiratory and cardiovascular systems. The thoracic cavity is divided into three major spaces:  1 central compartment, or mediastinum, houses the conducting structures that make up the thoracic viscera.  2 lateral compartments or pulmonary cavities for the lungs.

Thus the majority of the thoracic cavity is occupied by the lungs, which provide for the exchange of oxygen and carbon dioxide between air and blood, whereas most of the remainder of the thoracic cavity is occupied with structures involved in conducting the air and blood to and from the lungs. Nutrients traverse the thoracic cavity via the esophagus, to the abdomen.

The superior mediastinum extends inferiorly from the superior thoracic aperture to the horizontal plane that includes the sternal angle anteriorly and passes approximately through the junction (IV disc) of the T4 and T5 vertebrae posteriorly. and posterior parts. Unlike the rigid structure observed in the embalmed cadaver.Mediastinum The mediastinum is the central compartment of the thoracic cavity and contains all thoracic viscera except the lungs. The inferior mediastinum—between this plane and the diaphragm—is further subdivided by the pericardium into anterior. Some structures. The pericardium and its contents constitute the middle mediastinum. such as the esophagus. The superior mediastinum (above the transverse thoracic plane) is occupied by the trachea and upper parts of the great vessels. and most of the posterior mediastinum is occupied by structures vertically traversing all or much of the thorax. . The looseness of the connective tissue and the elasticity of the lungs and parietal pleura on each side of the mediastinum enable it to accommodate movement as well as volume and pressure changes in the thoracic cavity. pass vertically through the mediastinum and therefore lie in more than one mediastinal compartment. Occupying structures are hollow (fluid or air filled). The mediastinum (Latin. The mediastinum is artificially divided into superior and inferior parts for purposes of description. middle. the middle part of the inferior mediastinum is occupied by the heart. middle septum) is covered on each side by mediastinal pleura. the mediastinum in living people is a highly mobile region. It extends from the superior thoracic aperture to the diaphragm inferiorly and from the sternum and costal cartilages anteriorly to the bodies of the thoracic vertebrae posteriorly.

Anterior Mediastinum The anterior mediastinum. the anterior mediastinum contains the inferior part of the thymus. pulmonary trunk. In infants and children. and branches of the internal thoracic vessels. lies between the body of the sternum and the transverse thoracic muscles anteriorly and the pericardium posteriorly. The pericardium is a fibroserous membrane that covers the heart and the beginning of its great vessels. lymphatic vessels. The anterior mediastinum consists of loose connective tissue (sternopericardial ligaments). the smallest subdivision of the mediastinum. a few lymph nodes. . and roots of its great vessels — ascending aorta. It is continuous with the superior mediastinum at the sternal angle and is limited inferiorly by the diaphragm. fat. Pericardium The middle mediastinum includes the pericardium. and SVC—passing to and from the heart. heart.

the parietal layer of serous pericardium. The fibrous pericardium is inelastic. The serous pericardium is composed mainly of mesothelium. is continuous with (blends with) the central tendon of the diaphragm.The pericardium is a closed sac composed of two layers. The pericardium is a fibroserous sac.  The tough external layer. Pain impulses conducted from it by the somatic phrenic nerves result in referred pain sensations. the fibrous pericardium. It normally contains a thin film of fluid that enables the heart to move and beat in a frictionless environment. pulmonary trunk and veins. This layer is reflected onto the heart at the great vessels—aorta. If fluid or a tumor occupies the pericardial space. .  The internal surface of the fibrous pericardium is lined with a glistening serous membrane. invaginated by the heart and roots of the great vessels. Thus it holds the heart in its middle mediastinal position and limits expansion (filling) of the heart. that encloses the serous cavity surrounding the heart. The pericardial cavity is the potential space between layers of the parietal and visceral layers of serous pericardium. and superior and inferior venae cavae—as the visceral layer of serous pericardium. a single layer of flattened cells forming an epithelium that lines both the internal surface of the fibrous pericardium and the external surface of the heart. The parietal layer of the serous pericardium is sensitive. the capacity of the heart is compromised.

1. and the right and left ventricles are demarcated from each other by anterior and posterior interventricular (IV) grooves. The heart and pericardial sac are situated obliquely. a base. The left side of the heart receives well-oxygenated (arterial) blood from the lungs through the pulmonary veins and pumps it into the aorta for distribution to the body. The heart and roots of the great vessels within the pericardial sac are related anteriorly to the sternum. and anterior ends of the 3rd–5th ribs on the left side.39A). The atria are receiving chambers that pump blood into the ventricles. the atria are demarcated from the ventricles by the coronary or atrioventricular groove (L. slightly larger than a clenched fist. begins at the aortic orifice. and four sides. arising from the aortic sinuses. sulcus).The ascending aorta. The synchronous pumping actions of the heart's two atrioventricular (AV) pumps (right and left chambers) constitute the cardiac cycle. . suction and pressure pump. The heart is shaped like a pyramid with an apex. It end at the level of manubriosternal joint to become the arch of aorta Heart and Great Vessels The heart. usually approximately 9 cm (a hand's breadth) from the median plane. self-adjusting. Its only branches are the coronary arteries. is a double. Lies posterior to the left 5th intercostal space in adults. The apex of the heart (apex beat) Is formed by the left ventricle. costal cartilages. The right side of the heart receives poorly oxygenated (venous) blood from the body through the SVC and IVC and pumps it through the pulmonary trunk to the lungs for oxygenation (Fig. Externally. The heart has four chambers: right and left atria and right and left ventricles. approximately two thirds to the left and one third to the right of the median plane.

and aorta. . it is related mainly to the central tendon of the diaphragm. formed mainly by the right ventricle. esophagus.The base of the heart Is the heart's posterior aspect (opposite the apex) is formed mainly by the left atrium. The four surfaces of the heart (see figures above) are the:   Anterior (sternocostal) surface. Faces posteriorly toward the bodies of vertebrae T6–T9 and is separated from them by the pericardium. formed mainly by the left ventricle and partly by the right ventricle. It receives the right and left pulmonary veins and the superior and inferior venae cavae. Diaphragmatic (inferior) surface.

Right border formed by the right atrium and extending between the SVC and the IVC. formed by the right and left atria and auricles in an anterior view. formed mainly by the right ventricle and slightly by the left ventricle. formed mainly by the left ventricle.  Right pulmonary surface. 4. 3. The pulmonary trunk and arteries conduct poorly oxygenated blood to the lungs for oxygenation The coronary arteries. supply the myocardium and epicardium. 2. Left border formed mainly by the left ventricle and slightly by the left auricle. Left pulmonary surface. Inferior border. it forms the cardiac impression of the left lung. Superior border. The right and left coronary arteries (RCA and LCA) arise from the corresponding aortic sinuses at the proximal part of the ascending aorta. the ascending aorta and pulmonary trunk emerge from this border and the SVC enters its right side. . formed mainly by the right atrium. Its four borders are the: 1. the first branches of the aorta.

Part of the right ventricle. Most of the Interventricular septum (IVS) (usually its anterior two thirds) . Part of the left ventricle (the diaphragmatic surface). the RCA supplies       The right atrium. The AV node (in approximately 80% of people).Typically. Most of right ventricle. The SA node (in approximately 60% of people). the LCA supplies     The left atrium. Part (usually the posterior third) of the IV septum. Most of the left ventricle.