DOCSLIB.ORG

The Mediastinum—Is It Wide? Emerg Med J: First Published As 10.1136/Emj.18.3.183 on 1 May 2001

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Mediastinum—Is It Wide? Emerg Med J: First Published As 10.1136/Emj.18.3.183 on 1 May 2001 Emerg Med J 2001;18:183–185 183 The mediastinum—Is it wide? Emerg Med J: first published as 10.1136/emj.18.3.183 on 1 May 2001. Downloaded from C E Gleeson, R L Spedding, L A Harding, M Caplan Abstract Objective—To determine if the 8 cm upper limit for mediastinal width applies in the trauma setting of today. To define the upper limit of normal mediastinal width for supine chest films. Methods—A retrospective review of chest computed tomography scans was con- ducted to determine the width and posi- tion of the mediastinum within the supine chest. Radiographs were performed using a model that enabled the degree of mediastinal magnification to be ascer- tained in a variety of clinical settings. Figure 1 CT scan of the chest at the level of the aortic Results—The mean mediastinal width is arch. 6.31 cm. With standard radiographical techniques this mediastinum is magnified where pathology distorted the mediastinum to 8.93–10.07 cm. With minor adaptations were excluded. The remaining scans were then in radiographical technique this can be examined at the level of the maximum reduced to 7.31–7.92 cm. diameter of the aortic arch to determine: Conclusion—The 8 cm upper limit for (1) The composition and transverse diameter normal mediastinal width, set in the 1970s of the mediastinum at this level. does not apply in the modern trauma (2) The maximum width of the aortic arch. room. Changes in the position of the x ray (3) The distance from the anterior surface of cassette, and lengthening of the distance the aortic arch to the skin of the posterior between the patient and the x ray source chest wall. (The position to which the aor- will significantly reduce magnification. A tic arch gravitates in the supine chest). new range of upper limits is defined for The images were obtained on an Elscint the radiographical techniques possible in Twin II Helical scanner and stored on optical diVerent trauma settings. disk. The measurements were taken directly (Emerg Med J 2001;18:183–185) from the screen using an electronic cursor (fig http://emj.bmj.com/ 1). Two perpendicular lines from the edges of Keywords: mediastinum; radiography the object enabled measurement to be con- firmed at two points. At the completion of the series, accuracy was confirmed by re- Evaluation of mediastinal width on a supine measuring every fifth scan. chest film is now a standard part of the initial Having obtained these figures, we were able assessment of the trauma patient.1–3 In some to look at magnification in various simulated cases of mediastinal widening, it is clear that clinical settings. on September 27, 2021 by guest. Protected copyright. the mechanism of injury and the condition of Magnification is dependent on the: the patient should lead to further investigation. (1) Focus to film distance (FFD). The distance This may include contrast computed tomogra- from the x ray source (focus) to the x ray film phy (CT), transoesophageal echocardiography (fig 2). and definitive arch aortography.4–6 Interpret- (2) Object to film distance (OFD). The ation is a diagnostic challenge when the medi- distance between the object—that is, the astinum appears wide, the patient is well and mediastinum—and the x ray film (fig 2). the mechanism of injury is unlikely to have As FFD is increased, the x ray beams caused a traumatic rupture of the thoracic become more parallel and magnification is aorta. minimised. If OFD is increased, divergence of Studies in the 1970s suggested an upper the x ray beams produces greater magnification limit for mediastinal width of 8 cm–8.8 cm.78 of the object—that is, the mediastinum. Since then trauma management has changed Using wood, sponge and a commercially and therefore radiographic techniques have Accident and available x ray measuring tool, we assembled a Emergency, had to adapt. model. This enabled us to change the compo- Warrington Hospital It is our intention to discover whether these nents of the OFD. The following factors were NHS Trust, historical upper limits still apply and if not, to studied: Warrington define new upper limits. (1) Equipment variables—the depth of the Correspondence to: long spinal board, the depth of the Dr Gleeson, Methods mattress and the distance to the trolley’s x 25 The Village Gate, To ascertain the width of the normal mediasti- ray tray. Dalkey, Co Dublin, Ireland num and its position within the supine chest, (2) Patient variables—mediastinal depth and Accepted for publication we conducted an 18 month retrospective patient weight. Volunteers with weights 19 June 2000 review of chest CT scans of white adults. Scans varying from 50–90 kg lay supine on a long www.emjonline.com 184 Gleeson, Spedding, Harding, et al Typical Optimal Trauma short 100 cm FFD/short OFD long 180 cm FFD/short OFD shorter FFD/longer OFD Emerg Med J: first published as 10.1136/emj.18.3.183 on 1 May 2001. Downloaded from x-ray focus Divergent x-ray Spinal board beams Mediastinium x-ray cassette Wider mediastinal Wide mediastinal beneath trolley Parallel x-ray image image x-ray cassette beams Mattress Accurate mediastinal image Figure 2 How changing the FFD and OFD influences magnification. Table 1 Components of the mediastinum average aortic diameter was 4.6 cm (SD 0.95). However, the mean mediastinal width was 6.31 Aorta and: SVC 197 cm (SD 0.97). SVC and brachiocephalic 63 The anterior surface of the aorta was SVC and brachiocephalic and innominate 5 situated at a mean of 15.89 cm (SD 1.69) from Brachiocephalic 10 Three or more vessels 7 the skin of the posterior chest wall. The average Total 282 chest diameter was 21.06 cm (SD 2.47). The average long spinal board depth was 4.5 spine board. The resultant compression of cm. The distance between the spinal board and the mattress, beneath the board, was the x ray cassette tray beneath six types of measured to accurately calculate the eVect commercially available trolley varied between on OFD. 7.1–12.9 cm. Once the above were quantified radiographs Table 2 shows how the average 6.31 cm were taken using FFDs of 100, 140, and 180 mediastinum is magnified. In the 1970s supine cm. chest radiographs were exposed with 100 cm http://emj.bmj.com/ We then looked at the eVect these variables FFD and the x ray cassette directly beneath the had on the magnification of a range of medias- patient. This resulted in the mean mediasti- tinal widths. The geometry was then verified num being magnified to 7.5 cm. Using the against the verified formula for magnification.9 same FFD of 100 cm, with the longer OFD commonly used in the modern trauma setting, Magnification = FFD/FFD−OFD. the average mediastinum is magnified to 9.48 cm. Results However, by lengthening the FFD to 140 cm In the 18 month study period, 343 chest CT this can be improved to 8.29 cm. Further on September 27, 2021 by guest. Protected copyright. scans were reviewed. Altogether 282 (82%) improvement can be achieved by placing the x were suitable for inclusion in the study.The ray cassette beneath the spinal board—that is, other 61 scans were excluded because of shortening the OFD. The resultant mediastinal pathology in the chest or the abdomen distort- image is narrowed to 7.38 cm. ing the mediastinum. Data were analysed on a Table 3 shows the upper ranges of mediasti- SPSS package. nal widths. This range of new upper limits is At the level of the aortic knuckle, the dependent upon the FFD and the diVering mediastinum contained the aorta and the other positions for the x ray cassettes. Using the great vessels (table 1). In all cases, the superior standard used today of 100 cm FFD and long vena cava (SVC) contributed to the mediasti- OFD, the new upper limit for normal medias- nal width. The biggest contribution was when tinal width in 95% of the population is 12.4 the SVC lay beside the aorta. cm. By improving radiographic technique, with The values for the mediastinal and aortic a 140 cm FFD and the x ray cassette under the diameters were normally distributed. The Table 3 Magnification of the mediastinum 1 and 2 SD Table 2 Magnification of the average mediastinum (6.31 cm) in various clinical settings above the mean* x ray cassette placement x ray cassette placement Beneath spinal Beneath shallow Beneath Beneath Beneath Beneath deep FFD (cm) Beneath patient board trolley Beneath deep trolley FFD (cm) patient spinal board shallow trolley trolley 100 7.5 (7.17–7.89)* 7.95 (7.56–8.33) 8.7 (8.26–9.21) 9.48 (8.93–10.07) 100 8.67,9.83 9.18,10.40 10.05,11.39 10.94,12.40 140 7.12 (6.9–7.36) 7.38 (7.31–7.92) 7.86 (7.6–8.15) 8.29 (7.99–8.61) 140 8.22,9.32 8.54,9.68 9.08,10.29 9.56,10.84 180 6.92 (6.76–7.10) 7.45 (7.25–7.65) 7.45 (7.25–7.65) 7.75 (7.54–7.96) 180 8.0,9.07 8.67,9.32 8.60,9.75 8.94,10.14 *Range relates to chest depth. *Mediastinum located at the average AP depth within the chest. www.emjonline.com The mediastinum 185 spinal board the upper limit is a more FFD and long OFD (table 3).
Load more

Recommended publications
  • Of the Pediatric Mediastinum
    MRI of the Pediatric Mediastinum Dianna M. E. Bardo, MD Director of Body MR & Co-Director of the 3D Innovation Lab Disclosures Consultant & Speakers Bureau – honoraria Koninklijke Philips Healthcare N V Author – royalties Thieme Publishing Springer Publishing Mediastinum - Anatomy Superior Mediastinum thoracic inlet to thoracic plane thoracic plane to diaphragm Inferior Mediastinum lateral – pleural surface anterior – sternum posterior – vertebral bodies Mediastinum - Anatomy Anterior T4 Mediastinum pericardium to sternum Middle Mediastinum pericardial sac Posterior Mediastinum vertebral bodies to pericardium lateral – pleural surface superior – thoracic inlet inferior - diaphragm Mediastinum – MR Challenges Motion Cardiac ECG – gating/triggering Breathing Respiratory navigation Artifacts Intubation – LMA Surgical / Interventional materials Mediastinum – MR Sequences ECG gated/triggered sequences SSFP – black blood SE – IR – GRE Non- ECG gated/triggered sequences mDIXON (W, F, IP, OP), eTHRIVE, turbo SE, STIR, DWI Respiratory – triggered, radially acquired T2W MultiVane, BLADE, PROPELLER Mediastinum – MR Sequences MRA / MRV REACT – non Gd enhanced Gd enhanced sequences THRIVE, mDIXON, mDIXON XD Mediastinum – Contents Superior Mediastinum PVT Left BATTLE: Phrenic nerve Vagus nerve Structures at the level of the sternal angle Thoracic duct Left recurrent laryngeal nerve (not the right) CLAPTRAP Brachiocephalic veins Cardiac plexus Aortic arch (and its 3 branches) Ligamentum arteriosum Thymus Aortic arch (inner concavity) Trachea Pulmonary
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • CT-Based Mediastinal Compartment Classifications and Differential
    Japanese Journal of Radiology (2019) 37:117–134 https://doi.org/10.1007/s11604-018-0777-5 INVITED REVIEW CT‑based mediastinal compartment classifcations and diferential diagnosis of mediastinal tumors Takahiko Nakazono1 · Ken Yamaguchi1 · Ryoko Egashira1 · Yukari Takase2 · Junichi Nojiri1 · Masanobu Mizuguchi1 · Hiroyuki Irie1 Received: 16 July 2018 / Accepted: 10 September 2018 / Published online: 20 September 2018 © Japan Radiological Society 2018 Abstract Division of the mediastinum into compartments is used to help narrow down the diferential diagnosis of mediastinal tumors, assess tumor growth, and plan biopsies and surgical procedures. There are several traditional mediastinal compartment classifcation systems based upon anatomical landmarks and lateral chest radiograph. Recently, the Japanese Association of Research of the Thymus (JART) and the International Thymic Malignancy Interest Group (ITMIG) proposed new mediastinal compartment classifcation systems based on transverse CT images. These CT-based classifcation systems are useful for more consistent and exact diagnosis of mediastinal tumors. In this article, we review these CT-based mediastinal compart- ment classifcations in relation to the diferential diagnosis of mediastinal tumors. Keywords Mediastinum · Compartment · Computed tomography · Magnetic resonance imaging Introduction have resulted in confusion among physicians. In addition, the traditional models are based on lateral chest radiographs, The mediastinum is anatomically bound on the lateral side and thus some mediastinal lesions cannot be reliably local- by the parietal pleural refections along the medial aspects ized to a specifc compartment, since considerable overlap of both lungs, superiorly by the thoracic inlet, inferiorly by exists among the radiographically imaged compartments. the diaphragm, anteriorly by the sternum, and posteriorly Because mediastinal lesions are optimally evaluated with by the thoracic vertebral bodies.
    [Show full text]
  • Superior and Posterior Mediastina Reading: 1. Gray's Anatomy For
    Dr. Weyrich G07: Superior and Posterior Mediastina Reading: 1. Gray’s Anatomy for Students, chapter 3 Objectives: 1. Subdivisions of mediastinum 2. Structures in Superior mediastinum 3. Structures in Posterior mediastinum Clinical Correlate: 1. Aortic aneurysms Superior Mediastinum (pp.181-199) 27 Review of the Subdivisions of the Mediastinum Superior mediastinum Comprises area within superior thoracic aperture and transverse thoracic plane -Transverse thoracic plane – arbitrary line from the sternal angle anteriorly to the IV disk or T4 and T5 posteriorly Inferior mediastinum Extends from transverse thoracic plane to diaphragm; 3 subdivisions Anterior mediastinum – smallest subdivision of mediastinum -Lies between the body of sternum and transversus thoracis muscles anteriorly and the pericardium posteriorly -Continuous with superior mediastinum at the sternal angle and limited inferiorly by the diaphragm -Consists of sternopericardial ligaments, fat, lymphatic vessels, and branches of internal thoracic vessels. Contains inferior part of thymus in children Middle mediastinum – contains heart Posterior mediastinum Superior Mediastinum Thymus – lies posterior to manubrium and extends into the anterior mediastinum -Important in development of immune system through puberty -Replaced by adipose tissue in adult Arterial blood supply -Anterior intercostals and mediastinal branches of internal thoracic artery Venous blood supply -Veins drain into left brachiocephalic, internal thoracic, and thymic veins 28 Brachiocephalic Veins - Formed by the
    [Show full text]
  • ICD–9–CM Codes Denied
    Federal Register / Vol. 66, No. 226 / Friday, November 23, 2001 / Rules and Regulations 58837 Code Description 999.2 ................................................................. Other vascular complications 999.8 ................................................................. Other transfusion reactions V08 ................................................................... Asymptomatic HIV infection V12.1 ................................................................ History of nutritional deficiency V12.3 ................................................................ Personal history of diseases of blood and blood-forming organs V12.50–V12.59 ................................................. Diseases of circulatory system V15.1 ................................................................ Personal history of surgery to heart and great vessels V15.2 ................................................................ Personal history of surgery of other major organs V42.0 ................................................................ Kidney replaced by transplant V42.1 ................................................................ Heart replaced by transplant V42.2 ................................................................ Heart valve replaced by transplant V42.6 ................................................................ Lung replaced by transplant V42.7 ................................................................ Liver replaced by transplant V42.8 ...............................................................
    [Show full text]
  • THE ANATOMY and APPLIED ANATOMY of the MEDIASTINAL FASCIA by PAUL MARCHAND from the Thoracic Surgery Unit, Johannesburg Group of Hospitals
    Thorax: first published as 10.1136/thx.6.4.359 on 1 December 1951. Downloaded from Thorax (1951), 6, 359 THE ANATOMY AND APPLIED ANATOMY OF THE MEDIASTINAL FASCIA BY PAUL MARCHAND From the Thoracic Surgery Unit, Johannesburg Group of Hospitals (RECEIVED FOR PUBLICATION JULY 4, 1951) It is common knowledge amongst thoracic surgeons that the pulmonary arteries and veins at the hilum of the lung are invested by fascial sheaths. The hilar bronchi, too, have tough fascial investments which are readily demonstrated during dis- section pneumonectomy. Anatomical textbooks remain strangely silent upon the origin, and even upon the existence, of these fascial sheaths. Gray's Anatomy (1935) merely remarks that the fibrous pericardium is prolonged around the pul- monary arteries, " to be gradually lost upon the external coats of these vessels." It does not mention the existence of a definite sheath at the hilum of the lung related either to the pulmonary vessels or to the bronchus. It seems obvious that the fascial sheaths surrounding the pulmonary vessels are derived from the fibrous pericardium. copyright. There is no such ready explanation for the origin of the bronchial fascial sheath. The only possible source of this seems to be the pretracheal fascia, which is described as passing downwards from the neck into the superior mediastinum to fuse eventually with the fibrous pericardium. A review of the literature failed to provide any mention of lateral extensions of the pretracheal fascia around the bronchi. http://thorax.bmj.com/ In an effort to demonstrate the origin and distribution of these fascial planes 12 heart and lung specimens have been injected and dissected.
    [Show full text]
  • Anatomy of Lungs 6
    ANATOMYANATOMY OFOF LUNGSLUNGS - 1. Gross Anatomy of Lungs 6. Histopathology of Alveoli 2. Surfaces and Borders of Lungs 7. Surfactant 3. Hilum and Root of Lungs 8. Blood supply of lungs 4. Fissures and Lobes of 9. Lymphatics of Lungs Lungs 10. Nerve supply of Lungs 5. Bronchopulmonary 11. Pleura segments 12. Mediastinum GROSSGROSS ANATOMYANATOMY OFOF LUNGSLUNGS Lungs are a pair of respiratory organs situated in a thoracic cavity. Right and left lung are separated by the mediastinum. Texture -- Spongy Color – Young – brown Adults -- mottled black due to deposition of carbon particles Weight- Right lung - 600 gms Left lung - 550 gms THORACICTHORACIC CAVITYCAVITY SHAPE - Conical Apex (apex pulmonis) Base (basis pulmonis) 3 Borders -anterior (margo anterior) -posterior (margo posterior) - Inferior (margo inferior) 2 Surfaces -costal (facies costalis) - medial (facies mediastinus) - anterior (mediastinal) - posterior (vertebral) APEXAPEX Blunt Grooved byb - Lies above the level of Subclavian artery anterior end of 1st Rib. Subclavian vein Reaches 1-2 cm above medial 1/3rd of clavicle. Coverings – cervical pleura. suprapleural membane BASEBASE SemilunarSemilunar andand concave.concave. RestsRests onon domedome ofof Diaphragm.Diaphragm. RightRight sidedsided domedome isis higherhigher thanthan left.left. BORDERSBORDERS ANTERIORANTERIOR BORDERBORDER –– 1.1. CorrespondsCorresponds toto thethe anterioranterior ((CostomediastinalCostomediastinal)) lineline ofof pleuralpleural reflection.reflection. 2.2. ItIt isis deeplydeeply notchednotched inin
    [Show full text]
  • Inferior Mediastinum
    Inferior mediastinum • Below the imaginary plane passing from the sternal angle to the intervertebral disc between the fourth and fifth thoracic vertebra Subdivisions • Anterior mediastinum • Middle mediastinum • Posterior mediastinum Anterior mediastinum • Posterior to body of sternum & anterior to pericardial sac Contents- •Thymus • Sternopericardial ligaments • Lymph nodes • Mediastinal branches of internal thoracic vessels •Fat Middle mediastinum • Centrally located in the thoracic cavity • Contents- • Pericardium • Heart • Origin of the great vessels • Nerves & small vessels Posterior mediastinum • Located posterior to the pericardial sac & diaphragm & anterior to the bodies of the middle & lower thoracic vertebra Contents- • Esophagus & its associated nerve plexus • Thoracic aorta & it’s branches • Azygos system of veins • Thoracic duct & associated lymph nodes • Sympathetic trunk • Thoracic splanchnic nerves Esophagus • Muscular tube passing between the pharynx in the neck (CIV) to the cardiac end of the stomach (TXI) • 25cm,6thC-11th T • At lower end moves anterior & to the Left, Crosses from Right side of thoracic aorta to become anterior to it • Passes through the esophageal hiatus (TX) Constrictions of the esophagus • Junction of the esophagus with the pharynx (15cm from incisor teeth) • When the esophagus is crossed by the aorta (22.5cm) • When the esophagus is crossed by left main bronchus(27.5 cm) • At esophageal hiatus in diaphragm (40cm) • Innervation: Branches from vagus nerve & sympathetic trunk • Arterial supply: Inferior
    [Show full text]
  • NCD) Coding Policy Manual and Change Report (ICD-9-CM
    Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-9-CM) October 2015 Effective October 1, 2015, ICD-9-CM codes provided in this version are for historical purpose only. ICD-10-CM codes are valid for Medicare claim submission. Clinical Diagnostic Laboratory Services Health & Human Services Department Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 CMS Email Point of Contact: [email protected] TDD 410.786.0727 Fu Associates, Ltd. Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-9-CM) This is CMS Logo. NCD Manual Changes Date Reason Release Change Edit 01/12 *10/01/15 *Effective October 1, 2015, ICD-9-CM codes provided in this version are for historical purpose only. ICD-10-CM codes are valid for Medicare claim submission. *October 15 Changes – Red Fu Associates, Ltd. October 2015 ii Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report (ICD-9-CM) This is CMS Logo. Table of Contents NCD Manual Changes ................................................................................................................. ii Table of Contents ....................................................................................................................... iii Introduction ................................................................................................................................. 1 Non-covered ICD-9-CM Codes for All NCDs ............................................................................
    [Show full text]
  • 1. Anatomical Basis of Thoracic Surgery
    BWH 2015 GENERAL SURGERY RESIDENCY PROCEDURAL ANATOMY COURSE 1. ANATOMICAL BASIS OF THORACIC SURGERY Contents Lab objectives ............................................................................................................................................... 2 Knowledge objectives ............................................................................................................................... 2 Skills objectives ......................................................................................................................................... 2 Preparation for lab ....................................................................................................................................... 2 1.1 BASIC PRINCIPLES OF ANATOMICAL ORGANIZATION ............................................................................ 4 1.2 THORACIC CAVITY AND CHEST WALL ..................................................................................................... 9 1.3 PLEURA AND LUNGS ............................................................................................................................. 13 1.4 ORGANIZATION OF THE MEDIASTINUM .............................................................................................. 19 1.5 ANTERIOR mediastinum ....................................................................................................................... 23 Thymus ...................................................................................................................................................
    [Show full text]
  • Team Anatomy
    The Mediastinum This work is only for revision. The mediastinum It is a thick movable partition between the two pleural sacs & lungs. It contains all the structures which lie in the intermediate compartment of the thoracic cavity. Boundaries Superior: Thoracic outlet: (manubrium, 1st rib & Subdivisions 1st thoracic vertebra) The mediastinum is subdivided by a Horizontal plane (extending from the Sternal angle to the lower border of T4) into: Superior mediastinum (S): above the plane Level of T4 is at the Level of: Anterior: • Sternal angle • Second costal cartilage Sternum. Inferior mediastinum: below the plane. • Bifurcation (1) of trachea • Bifurcation of pulmonary trunk (2) • Beginning & termination of arch of aorta Posterior: The 12 thoracic PHRENIC NERVES vertebrae Root Value: C3,4,5 (3) They pass through the Superior & Middle mediastina Course in Thorax: q The right phrenic descends on the right side of the Inferior: Superior Vena Cava & heart. Diaphragm. q The left phrenic descends on the left side of heart. q Both nerves terminate in the diaphragm Branches : 1) Motor & Sensory fibers to Diaphragm عّرﻔﺗ :pericardium (1) bifurcation & pleurae to fibers Sensory (2 (2) Pulmonary trunk: a major vessel of the human heart that originates from the right ventriCle and branches into the right and left pulmonary arteries. (3) MNM: three, four, five. keeps the diaphragm alive Superior Mediastinum Boundaries Contents: (A) Superficial (B) (c) Deep Superior: Thoracic outlet. Intermediate Posterior: Anterior: Upper (4) Manubrium. thoracic vertebrae. (1) Inferior: Horizontal plane. The aorta has three branches : (c) Deep: 1. Brachiocephalic artery. Trachea 2. Left common carotid artery. Esophagus (1) Both right and left brachiocephalic veins are superficial.
    [Show full text]
  • Clinical Anatomy of the Pleural Cavity & Mediastinum
    ClinicalClinical AnatomyAnatomy ofof thethe PleuralPleural CavityCavity && MediastinumMediastinum Handout download: http://www.oucom.ohiou.edu/dbms-witmer/gs-rpac.htm LawrenceLawrence M.M. Witmer,Witmer, PhDPhD Department of Biomedical Sciences College of Osteopathic Medicine Ohio University Athens, Ohio 45701 [email protected] PleuraPleura andand PleuralPleural CavityCavity Pleura • Mesothelial lining of each hemithorax • Derived from embryonic coelomic lining • Visceral pleura: lung • Parietal pleura: wall • Costal • Diaphragmatic • Mediastinal • Cervical From Moore & Dalley 1999 Pleural Cavity • Potential space between visceral & parietal pleura • Capillary layer of serous fluid produced by mesothelium • Reduces friction • Surface tension provides cohesion between lung and thoracic wall PleuralPleural sacsac andand recessesrecesses endothoracic fascia From Healey & Hodge 1990 PleuralPleural DiseasesDiseases && SignsSigns 1:1: PleuralPleural EffusionEffusion • Accumulation of fluid in the pleural space • Transudative vs. exudative effusion • Empyema as potential sequelae to exudative effusion Right-sidedRight-sided pleuralpleural effusioneffusion FromFrom DaffnerDaffner 19931993 PleuralPleural DiseasesDiseases && SignsSigns 2:2: HemothoraxHemothorax • Intrathoracic bleeding (e.g., trauma) • Numerous sources of potential bleeds • Large hemothorax: hypovolemic shock, restricted ipsilateral ventilation contralateral mediastinal shift • Clotting may not be too problematic (except for catheters) FromFrom NetterNetter 19881988
    [Show full text]