Heart and Mediastinum
Esophagus
MEDIASTINUM central compartment of thoracic
cavity; each side covered by mediastinal pleura;
hollow visceral structures united by loose CT and
often infiltrated by fat
DIVISIONS
Boundaries:
Sup to Inf Superior thoracic aperture to
diaphragm
Ant to Post Sternum and coastal cartilages
to the bodies of the thoracic vertebrae
Laterally mediastinal pleura and some
parts of parietal pleura of lungs
Contents:
Remnants of Thymus
Heart and large blood vessels
Trachea and esophagus
Thoracic duct and lymph nodes
Vagus and phrenic nerves
Subdivisions:
Transverse thoracic plane passes from
sternal angle through T4 and T5; divides
into sup and inf mediastinum
SUPERIOR DIVISION
Contents:
Thymus primary lymphoid organ;
develops from 3rd brachial pouch; nag
eextend to inferior division sa bata; grows
til puberty (involution na); superior part:
posterior of pericardium
Veins
Brachiocephalic vein
Superior vena cava
Arteries
Arch of aorta
Roots of brachiocephalic trunk
Left common carotid artery
Left subclavian artery
Related nerves
Phrenic nerve
Vagus nerve
Cardiac plexus
Trachea
Left recurrent laryngeal nerve
Thoracic duct and lymphatic trunk
Blood supply: Anterior intercoastal artery; anterior
mediastinal branches of internal thoracic artery
Venous drainage: Left brachiocephalic vein,
internal thoracic vein and interior thyroid veins
Lymphatic drainage: parasternal, brachiocephalic
and tracheobronchial
INFERIOR DIVISION: Subdivided into: anterior,
middle and posterior by PERICARDIUM
1. Anterior smallest, between sternum and
pericardium
Contents:
Sternopericardial ligaments
Fat
Lymphatic vessels and nodes
Branches of internal thoracic vessels
Inferior part of thymus (infants and childre)
2. Middle within pericardium
Contents:
Pericardium
Heart
Roots of great vessels: ascending aorta,
pulmonary trunk, and superior vena cava
Arch of Azygos vein
Main bronchi
3. Posterior anterior to T5-T12, between
parietal pleura
Contents
Thoracic aorta
Thoracic duct
Tracheobronchial nodes
Azygos and Hemiazygos veins
Esophagus
Esophageal plexus
Thoracic sympathetic trunks and thoracic
sympathetic nerves
VEINS
1. Brachiocephalic veins (R and L)
- Union of IJV and subclavian vein
 - L is longer than R, crosses midline, L divides into R common carotid
joins R to form SVC and right subclavian arteries
- Shunt blood from head neck and upper 2. Left common carotid artery 2nd
limbs to R atrium branch; ascends posterior to
- R venous angle origin of R; receive aorta, slightly posterior and to
lymph from R lymphatic duct the left of brachiocephalic trunk,
- L venous angle origin of L; receive and anterior to the L subclavian
lymph from thoracic duct artery
2. Superior Vena Cava - valveless 3. Left subclavian artery 3rd
- Union of R and L brachiocephalic veins branch, arises from posterior
- Drains into R atrium at level of 3rd part of arch, post. to L common
intercostal cartilage artery; ascends lateral to trachea
- Right side of superior mediastinum, ant. and L common carotid artery
to trachea; posterolateral to ascending through superior mediastinum
aorta
- Joined by azygos before entering NOTE: Ligamentum arteriosum serves as landmark
pericardium for L recurrent laryngeal nerve (hooks underneath
- Terminal half: nasa middle, beside aortic arch, lateral to ligamentum arteriosum)
ascending aorta and forming posterior remnant of fetal ductus arteriosus; passes from
boundary of transverse pericardial sinus root of pulmonary artery to inf. surface of arch of
aorta; found in inferior margin of aortic arch and at
3. Inferior Vena cava larger than svc the origin of L pulmonary artery
- In abdomen, perforates the central
tendon of the diaphragm and the c. Descending aorta
pericardium - Thoracic aorta: continuation of aortic
- May rudimentary and functionless valve arch; begins at L side of inferior body of
T4 then descends in posterior
ARTERIES mediastinum on L side of T5-T12;
1. Aorta from aortic orifice on L ventricle; approaches median plane as it descends
consists of: and displaces esophagus to the right
a. ascending aorta (branches: R and L
coronary arteries)
b. arch of aorta (continuation ng
ascending, taas ng TTP; from 2nd right
sternocostal joint sa posterior magiging
thoracic aorta sa 2nd left sternocostal
joint; arches superoposteriorly to L and
ascends anterior to R pulmonary artery
and bifurcation of traches; descends on
L side and continues as descending
aorta from T4 vertebral body)
Branches of aortic arch
1. Brachiocephalic trunk 1st and
largest branch; posterior to
manubrium; ant. to trachea,
post. toL BC vein, ascends
superolaterally and reaches R
sife of trachea and right SC joint;