Mediastinum

By
Dr B.A. Hottor (MB ChB; PhD)

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 Aim

• To study the anatomical space called

mediastinum and its contents
 Objectives
• By the end of the session you should be
able to:
o Define the term mediastinum and its boundaries
o List the various divisions the mediastinum.
o Describe the important contents of the mediastinum
e.g., the thymus gland, trachea, esophagus, thoracic
duct, aorta, azygos system of veins.
o Be able to examine for shift in the mediastinum and
enumerate the possible causes of mediastinal shift

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 Mediastinum
• It is the central compartment of the thoracic cavity.
• It contains all thoracic viscera and structures except the
lungs
• It is a very mobile structure because it contains hollow
structures
• Its movement depends on the movement of the
structures it contains and that of the lungs

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 The Mediastinum
• Definition:
o Strictly it is the
partition/space between
the lungs, including the
mediastinal pleura.
o The term is commonly
applied to the region
between the two pleural
sacs.
 Mediastinum: Boundaries
• It extends from superior-
thoracic inlet to the
abdominal diaphragm.
• Anterior-Sternum and
costal cartilages
• Posterior-Thoracic
vertebral column.
• .
Divisions of the mediastinum
• Superior
• Inferior:
o Anterior
o Middle
o posterior
Transverse
thoracic
plane

The major divisions of the mediastinum

 Superior mediastinum
• Lies between manubrium sterni and the first 4
thoracic vertebrae.
• Superior boundary is thoracic inlet
• Inferiorly boundary is transverse thoracic
plane:
o Arbitrary line from the sternal angle (manubriosternal
joint) anteriorly to the lower surface of T4 posteriorly
• Laterally by the mediastinal pleurae
 Contents of superior
mediastinum
• From anterior to posterior:
o Thymus
o Veins-brachiocephalic, and SVC
o Arteries- arch of aorta, roots of
brachiocephalic trunk, left common
carotid and left subclavian
o Trachea
o Oesophagus
o Thoracic duct and Right lymphatic duct
o Nerves – vagus, phrenic nerve, cardiac
plexus

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 Anterior mediastinum
• Located behind the body of
sternum and pericardium
• It extends from TTP to
diaphragm
• Contents:
o loose connective tissue
o Sternopericardial ligaments
o Lymph nodes
o Mediastinal branches of the internal
thoracic artery
o Thymus gland (part) or its degenerated
remains
 Middle mediastinum

• Boundaries
o Superior
o Anterior
o Posterior
o Inferior
 Middle mediastinum: Contents
 Pericardium
 Heart
 Great vessels
• Trachea bifurcation and main
bronchi
 Nerves
 Lymph nodes
 Posterior mediastinum
• Boundaries:
o Anterior:- bifurcation of the
trachea, pulmonary vessels,
pericardium and the posterior
part of the upper surface of the
diaphragm.
o Posterior:- vertebral column,
from T5-T12 vertebrae.
o Lateral:- mediastinal pleura.
Posterior mediastinum: Content
• Arteries-Descending thoracic aorta,
• Veins-The azygos, Hemiazygos and
accessory azygos veins;
• Nerves- The right and left
sympathetic chains, The splanchnic
nerves, The right and left vagi
• The oesophagus
• The thoracic duct and
• Posterior mediastinal lymph nodes.
 Thymus Gland
• Io lymphoid organ
• Located in the lower part of
neck and anterior part of
superior and superior
mediastinum
• Flate gland with flask-shaped
bilobes
• Blood supply- It has rich blood
supply from inferior thyroid
artery, internal thoracic artery,
ant intercostal; corresponding
vein
 Major blood vessel
• Brachiocephalic veins
• Superior vena cava
• Ascending Aorta
o 2.5 cm in diameter
o Begins at the aortic orifice
o Only branches are the 2 coronary
arteries
o It is located in the pericardium and
therefore considered the content of
middle mediastinum
Arch of Aorta

19
 Trachea
• 10 cm long, 2 cm in
diameter
• Begins at the lower border
of cricoid cartilage level
with C6 vertebra (5 cm
above the jugular notch)
• End (T5, sternal angle)
• Relation
Trachea
•Blood supply - inferior
thyroid artery,
bronchial artery
•Nerve supply – Vagus
supply the mucosa,
sympathetic supply the
smooth muscle
•Structure
• 15-20 c-shaped
hyaline cartilage
rings
• Trachealis
 Oesophagus
15 cm from incisor
teeth
• Fibromuscular tube
• 25 cm long
• Begins at the lower border of
cricoid cartilage (C6 vertebra) 22 cm

• Passes through the diaphragm at

T10 27 cm
• Enter the stomach at T11
• Blood supply
• Constrictions 38 cm
 Relations in the thorax
• Anterior relations:-trachea, LT Recurrent laryngeal N., LT
main bronchus, pericardial sac and LA; below the lung roots-
esophageal plexus, LT vagus
• Posterior relations:- bodies of the thoracic vertebrae, thoracic
duct, azygos veins, RT posterior intercostal arteries,
descending thoracic aorta, RT vagus
• RT relations:-mediastinal pleura and Azygos veins
• LT relations:-LT subclavian artery, Arch of aorta, Thoracic
duct, and mediastinal pleura

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 Oesophagus: Relation

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 Blood supply
• Blood supply is from the inferior thyroid
artery, branches of the descending thoracic
aorta and the left gastric artery.
• The veins from the cervical part drain into the
inferior thyroid veins, from the thoracic
portion into the azygos vein and from the
abdominal portion partly into the azygos and
partly into the left gastric veins

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 Structure (microscopic)
• Outer connective tissue layer of areolar (adventitia/serosa)
• a muscular layer of external longitudinal and internal circular
fibres which are striated in the upper two-thirds and smooth in
the lower one-third;
• Submucosa containing blood vessels, nerves and lymphatic
vessels and mucous glands (MG)
• Mucosa consist of stratified squamous non-keratinizing
epithelium and lamina propria containing MG

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 Histology of the
esophagus
T/S esophagus

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 Histology of the
esophagus.

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 Oesophageal sphincters
• Upper (pharyngoesophageal)sphincter
o True sphincter formed by cricopharygeus muscle
o It prevents air from entering the oesophagus during swallowing

• Lower oesophageal (gastroesophageal) sphincter

o Not a true anatomical sphincter
o Prevent gastric reflux into oesophagus

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 Constrictions
• Distance from the upper 15 cm
incisor teeth
• Common site of foreign
body impaction and stricture
formation after ingestion of 22 cm
corrosives 27 cm

38 cm

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 Foreign bodies in the
oesophagus
• Common in children, mentally disturbed and elderly
• Materials include, coins, pins, meat, fish bones and dentures
• Complications include:
o Perforation
o Rapture with mediastinitis
o stricture
o Tracheoesophageal fistula

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 Oesophageal injuries
• Iatrogenic –from instrumentation
• Chemical ingestion
• Penetrating injuries

B.A. Hottor, Anatomy 04/10/2024 32

 Descending thoracic aorta
• Continuation of the arch of
aorta
• Begin at the lower border of
T4
• Becomes the abdominal aorta
at the level of T12
• Overlies the thoracic vertebrae
• Branches:
o Bronchial arteries
o Oesophageal arteries
o Posterior intercostal arteries (3- 11)
o Subcostal arteries
o Superior phrenic

33
 SYMPATHETIC TRUNK
• 2 ganglionated trunks
• Extend the entire length of
vertebral column
• Ganglia
• Cervical-3
• Thoracic-10 to12 (usually 11)
• Lumbar-4
• Sacral-4 or 5

• Ganglion impar
 Azygos system of veins
• A system of veins that drain the back and thoracic and
abdominal wall and mediastinal viscera
• They includes:
• Azygos vein- formed by right ascending lumbar and right
subcostal; it drains into SVC
• Hemiazygos vein- formed by the union of left ascending
lumbar and left subcostal veins. It receives blood from the
lower 4 posterior intercostal vein and joins the azygos
• Accessory hemiazygos: starts in the 4th intercostal space;
receive 4th to 8th posterior intercostal veins and joins the
azygos vein.
 Thoracic duct
• Main lymphatic vessel of the body
• Receives lymph from the entire body except the right upper
limb and right side of the head and neck
• Begin in the abdomen just inferior to the diaphragm as the
cisterna chyli
• It empties into the junction between the left internal jugular
vein and the left subclavian vein
 END…..
THANK YOU!