Superior and Posterior Mediastinum. Assoc. Prof. Jenny Hayes

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1 Superior and Posterior Mediastinum Assoc. Prof. Jenny Hayes

2 WARNING This material has been provided to you pursuant to section 49 of the Copyright Act 1968 (the Act) for the purposes of research or study. The contents of the material may be subject to copyright protection under the Act. Further dealings by you with this material may be a copyright infringement. To determine whether such a communication would be an infringement, it is necessary to have regard to the criteria set out in Part 3, Division 3 of the Act.

3 Objectives The layout and contents of the superior and posterior mediastinum The course of the ascending aorta, arch of aorta, descending thoracic aorta and the major branches of each The origin, course and relations of the jugular, subclavian, brachiocephalic veins and SVC (and be aware of the azygous system of veins) The course and major relationships of trachea, oesophagus, thoracic duct, vagus and phrenic nerves Suggested pre-reading Gray s Anatomy for Students: Regional anatomy of Superior and Posterior mediastinum, Chapter 3, Thorax, p , 2 nd ed. OR Clinicall y Orientated Anatomy, Moore: Superior mediastinum and great vessels, posterior mediastinum, Chapter 1, Thorax, p , 6 th ed.

4 Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #186

5 Moore K L. Clinically Oriented Anatomy. 2nd ed. Williams and Wilkins; ISBN Ch.1 Page54

6 Superior mediastinum From superficial deep thymus great veins aortic arch vagus + phrenic nerves trachea oesophagus thoracic duct L recurrent laryngeal nerve Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #201

7 brachiocephalic veins IJV subclavian vein SVC right atrium IVC Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #201

8 Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #226A Azygous vein Central vein catheterization:

9 Arch of aorta Left pulmonary artery Left main bronchus Pulmonary veins Descending thoracic aorta Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #219

10 Ligamentum arteriosum Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #201

11 Right common carotid Left common carotid Right subclavian Left subclavian Brachiocephalic trunk Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #182A

12 Moore K L. Clinically Oriented Anatomy. 6th ed. Lippincott,Williams and Wilkins; ISBN Ch.1 Page 174

13 Phrenic nerve C3,4,5 on scalenus anterior b/w subclavian artery+vein anterior to lung root pierces diaphragm Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #201

14 Right phrenic nerve is lateral to venous structures: SVC,R atrium, IVC Left phrenic nerve is lateral to arterial structures: Aortic arch and L ventricle Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #182A

15 Motor supply to the diaphragm from its abdominal surface Sensory to mediastinal + diaphragmatic pleura + pericardium Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #181

16 Vagus nerve Cranial nerve Posterolateral to CCA Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #182A

17 R vagus nerve Alongside trachea Behind lung root Anterior oesophagus Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #218

18 Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy Lippincott Williams & Wilkins, 2009, ISBN: , p.204

19 L vagus nerve superior IC vein phrenic nerve L recurrent laryngeal nerve Lateral to aortic arch* *posterior to phrenic n *crossed by superior IC vein *gives of L recurrent laryngeal nerve Behind lung root Anterior oesophagus Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #219

20 Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #201

21 Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #220

22

23 Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: , p.198

24 Descending thoracic aorta Left of vertebral column Approaching midline Midline Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #220

25 Branches of descending thoracic aorta Intercostal Bronchial Pericardial Oesophageal Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Plate #220

26 Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: , p.198

27 Hansen,J.T. Netter s Clinical Anatomy. 2nd ed. Elsevier, 2010, ISBN: , p.108

28 Relevant museum specimens displayed (beneath windows) Head & Neck Bay: is a a dissection of the root of the neck and the superior mediastinum. On the right side, part of the anterior wall of the thorax and some superficial muscles have been removed. Thorax Bay: is a dissection of the mediastinal contents showing the relations of the trachea, the oesophagus, the thoracic duct and the left recurrent laryngeal nerve; the relations of the aortic arch and its branches to the vagus and phrenic nerves. In addition, it shows the relations of the great vessels to the pericardium and of the thyroid gland to the carotid sheath. Images and information on these specimens can also be accessed via the museum online database: An excellent pre-workshop and pre-dissection resource is Acland s anatomy:

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