MEDIASTINUM

By Mr M R Karim
MBBS , MRCS , MSc
 To get gross idea about mediastinum

To know the boundaries of different

mediastinum
Learning To understand the contents and relations
of different mediastinum
Objectives
To understand different clinical cases
related to mediastinum
To know surgical anatomy , pathology
and surgical importance of mediastinum .
 • The mediastinum is a space in the thorax that
contains a group of organs, vessels, nerves,
lymphatics and their surrounding connective tissue.
What is
Mediastinum ??? • The mediastinum houses many vital structures including the
heart, great vessels, trachea, and essential nerves. It also
functions as a protected pathway for structures traversing
from the neck, superiorly, and into the abdomen, inferiorly.
 • The four-compartment divides the mediastinum into
the superior, anterior, middle, and posterior portions. The
Compartments mediastinum houses many vital structures including the
heart, great vessels, trachea, and essential nerves.
Mediastinum
 • The superior mediastinum is bordered by the following
SUPERIOR thoracic structures:

MEDIASTIN • Superior – Thoracic inlet.

• Inferior – Continuous with the inferior mediastinum at the
UM level of the sternal angle.
( boundaries) • Anterior – Manubrium of the sternum.
• Posterior – Vertebral bodies of T1-4.
• Lateral – Pleurae of the lungs.
 SUPERIOR
MEDIASTIN • Organs: thymus, trachea, oesophagus.
• Arteries: aortic arch, brachiocephalic trunk, left common
UM carotid artery, left subclavian artery.

( Contents) • Veins and lymphatics: superior vena cava, brachiocephalic

veins, the arch of the azygos, thoracic duct.
 MIDDLE • The middle mediastinum is the region bounded by:
MEDIASTIN • anteriorly: the anterior margin of the pericardium.

UM • posteriorly: the posterior border of the fibrous

pericardium.
( Boundaries) • superiorly: an arbitrary plane passing horizontally and
posteriorly from the manubriosternal joint to the inferior
border of the T4 vertebra.
 MIDDLE Organs: The heart and its great vessel roots, trachea and main
MEDIASTIN bronchi.

UM Arteries: Ascending aorta, pulmonary trunk,

( Contents) pericardiophrenic arteries.

Veins and lymphatics: Superior vena cava, pulmonary veins,

pericardiophrenic veins
POSTERIOR
MEDIASTIN • The posterior mediastinum is bordered by the following
thoracic structures:
UM • Lateral: Mediastinal pleura (part of the parietal pleural

(Boundaries) membrane).
• Anterior: Pericardium.
• Posterior: T5-T12 vertebrae.
POSTERIOR
MEDIASTIN • Organs: oesophagus.
• Arteries: descending thoracic aorta.
UM • Veins and lymphatics: azygos hemiazygos veins, thoracic
(Contents) duct.
• Nerves: vague, splanchnic, sympathetic chain
• MEDIASTINU
M
( imaging)
MEDIASTIN
UM ( CT
imaging)
Q/A

• Which of the following structures is not located within the mediastinum?

• A. Thymus
• B. Heart
• C. Great vessels
• D. Arch of azygos vein
• E. Vertebral bodies
Q/A

• Which of the following is not contained within the middle mediastinum?

• A. Main bronchi
• B. Arch of the azygos vein
• C. Thoracic duct
• D. Pericardium
• E. Aortic root
Q/A

• During a gangland gunfight a man is shot in the chest. The bullet passes through the posterior
mediastinum (from left to right). Which of the following structures is least likely to be injured?
• A. Thoracic duct
• B. Oesophagus
• C. Vagus nerve
• D. Descending thoracic aorta
• E. Arch of the azygos vein
 • Anatomy: A Photographic Atlas
Rohen MD, Johannes W.; Yokochi MD, Chihiro;
Lütjen-Drecoll MD, Elke

• Abrahams' and McMinn's Clinical Atlas of

Human Anatomy

REFERENCES : • Netter's Atlas of Human Anatomy

•
https://www.ncbi.nlm.nih.gov/books/NBK539819/

• Google Photos
• www.emrcs.com
• https://en.wikipedia.org/wiki/Mediastinum