Superior and Posterior Mediastinum Assoc. Prof. Jenny Hayes
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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. 204-223, 2 nd ed. OR Clinicall y Orientated Anatomy, Moore: Superior mediastinum and great vessels, posterior mediastinum, Chapter 1, Thorax, p.160-170, 6 th ed.
Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #186
Moore K L. Clinically Oriented Anatomy. 2nd ed. Williams and Wilkins; 1985. ISBN 0683061321. Ch.1 Page54
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: 1-929007-15-9, Plate #201
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: 1-929007-15-9, Plate #201
Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #226A Azygous vein Central vein catheterization: http://www.youtube.com/watch?v=fxjvvsbgvte http://www.youtube.com/watch?v=elxn89aycwe&nr=1 http://www.youtube.com/watch?v=w6y_bbqhgmc&feature=related
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: 1-929007-15-9, Plate #219
Ligamentum arteriosum Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #201
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: 1-929007-15-9, Plate #182A
Moore K L. Clinically Oriented Anatomy. 6th ed. Lippincott,Williams and Wilkins; 2010. ISBN 978-1-60547-652-0. Ch.1 Page 174
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: 1-929007-15-9, Plate #201
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: 1-929007-15-9, Plate #182A
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: 1-929007-15-9, Plate #181
Vagus nerve Cranial nerve Posterolateral to CCA Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #182A
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: 1-929007-15-9, Plate #218
Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.204
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: 1-929007-15-9, Plate #219
Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #201
Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: 1-929007-15-9, Plate #220
Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.198
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: 1-929007-15-9, Plate #220
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: 1-929007-15-9, Plate #220
Tank,P.W. and Gest T.R. Lippincott Williams & Wilkins atlas of Anatomy. Lippincott Williams & Wilkins, 2009, ISBN: 978-0-7817-8505-1, p.198
Hansen,J.T. Netter s Clinical Anatomy. 2nd ed. Elsevier, 2010, ISBN: 978-1-4377-0272-9, p.108
Relevant museum specimens displayed (beneath windows) Head & Neck Bay: 516-100084 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: 516-100208 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: http://mdhs.unimelb.edu.au/harrybrookesallenmuseum/catalogue An excellent pre-workshop and pre-dissection resource is Acland s anatomy: http://www.aclandanatomy.com.ezp.lib.unimelb.edu.au/