Date post: | 13-Apr-2017 |
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Health & Medicine |
Upload: | nepalese-army-institute-of-health-sciences |
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Thorax - boundaries
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Plane of Inlet
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45°
Superior Thoracic Aperture
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Suprapleural membrane/ Sibson’s fascia
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Suprapleural membrane: Relations
Inf thoracic aperture-Diaphragm- ant view
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Layers in thoracic wall
Thoracic cavity
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Pleura: Layers1. Visceral
2.Parietal
• Cervical
• Costal
• Diaphragmatic
• Mediastinal
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Parietal pleura
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Pleura: Parts
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PLEURAL REFLECTIONS
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Surface marking
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Surface marking
Pulmonary ligament
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Pleural recesses
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Nerve supply of Pleura Parietal pleura - somatic nerves - Intercostal & phrenic nerve - pain sensitive
Visceral pleura - autonomic nerves - (T2 to T5) & vagus
- pain insensitive
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Mediastinum
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Mediastinum: Boundaries & SUBDIVISIONS
Superior Mediastinum: Boundaries
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• Ant: Manubrium sterni
• Post: T-1 to T-4
• Sides: Mediastinal pleura
• Sup: Plane of thoracic inlet
• Inf: Imaginary line joining
sternal angle and lower
border T-4
Superior Mediastinum - contents
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Superior Mediastinum: Contents
• Muscles:
•Sternohyoid
•Sternothyroid
•Longus colli
• Thymus: in childhood & puberty
• Trachea & Esophagus
• Thoracic Duct
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• Veins • SVC• Lt & Rt brachiocephalic veins• Supreme intercostal veins• Lt Superior Intercostal vein
• Arteries:• Arch of Aorta • Brachiocephalic artery• Lt Common carotid • Lt subclavian artery
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Anterior Mediastinum: Contents
• Thymus (Children)
• Sternopericardial ligaments
• Internal thoracic artery & branches
• Lymphatics & Lymph nodes
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Middle Mediastinum: Contents cont.
Heart enclosed in pericardium
Arteries: Ascending Aorta, Pulmonary trunk with its branches
Veins: SVC, Termination of Azygos, Pulmonary veins
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• Nerves: Phrenic, Deep cardiac plexus
• Bifurcation of Trachea with two principal bronchi
• Tracheobronchial lymph nodes
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Posterior
Mediastinu
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Contents
Posterior Mediastinum: Contents
• Esophagus• Thoracic duct• Arteries : Descending Aorta with its brs
• Veins: Azygos, Hemiazygos & Accessory hemiazygos
• Nerves: Vagus & Splanchnic nerves• Lymph nodes: Posterior mediastinal
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Applied Anatomy
• Pleuritis/pleurisy
• Pleural effusion / hydrothorax
• Haemothorax
• Empyema
• Referred pain - from diaphragmatic pleura
• Pleural tapping
• Pneumothorax – open, closed, tension33
Tension Pneumothorax• Distended neck veins• Tracheal shift• Decreased breath sounds• Hyper resonance (involved
hemithorax)• Collapsed lung on same
side• Medical emergency• Tt : Needle decompression
2nd ICS in MCL
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Needle decompression 2nd ICS in MCLNeedle decompression 2nd ICS in MCL
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Applied AnatomyApplied Anatomy
• Mediastinitis• Mediastinoscopy
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Mediastinoscopy
Mediastinoscopy
• Intro: Visualization of mediastinum +- biopsy• Indications:
– Staging of lymph nodes of lung cancer– Diagnose sarcoidosis or lymphoma.
• Procedure:– Incision 1 cm above the suprasternal notch– Dissection in pretracheal space upto carina. – Mediastinoscope advanced into the created tunnel – View of the mediastinum
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• Superior Mediastinal syndrome obstruction to SVC
• Engorgement of veins• Dyspnea• Dysphagia• Hoarseness of voice
• Mediastinal shift
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