The Superior Mediastinum

Boundaries
Sup.: Anatomical thoracic inlet

Inf.: Imaginary line

Ant.: manubrium

Post.: T1-T4

Contents
1. Brachiocephalic veins & SVC 2. Aortic arch & branches: brachiocephalic lf. C.C.a. Lf. Subclavian a. 3. Vagus & Phrenic n.

4. Trachea
5. Esophagus

Brachiocephalic Veins
Formed by union : Int. Jug. v. & Subclavian v. (at sternoclavicular joints) Lf.: longer (6 cm) pass post. to manubrium ant. to aortic branches Rt.: 2-3 cm vertical to right 1st cc Unite behind Rt. 1st cc to form SVC

Superior Vena Cava (SVC)

Starts behind Rt. 1st cc Ends behind Rt. 3rd cc Rt. Atrium Relations: Ant.: Rt. Lung & covering pleura Post.: root of Rt. Lung Medial: Ascending aorta Lateral: Rt. Phrenic & Rt. lung Tributaries: Azygos Vein: path & drainage? 3

posteroanterior chest x-ray

SVC

Aorta
4 Parts:
1. Ascending Aorta: lies within fibrous pericardium sup. to Rt. Until Rt. 2nd cc 2 branches? 2. Arch: curved continuation (sup. mediast) Rt. 2nd cc arches supero-posterior to Lf. Side infero-posterior Lf. Side of T4 body 3 branches?

3. Descending Thoracic Aorta: within post. mediastinum post. intercostal a. (except?) subcostal a.
bronchial, pericardial & esophageal

opposite to T12 (aortic opening) 4. Abdominal Aorta: starts at T12- L1 ends by dividing into: Rt. & Lf. common iliac a. at L4

Arch of Aorta
Start ? Ends? Relations: Arches over: Rt. Pulmonary a. & Lf. Main bronchus Crossed ant.: Lf. Vagus & phrenic n. Rt.: Trachea & Esophagus

Lf. Recurrent laryngeal n. loops around the arch as it arise from the vagus

posteroanterior chest x-ray

Aorta:
Ascending & arch

Branches of The Arch

1. Brachiocephalic a.: (Rt.) largest branch S-C joint Rt. CC a. & Rt. Subclavian a. 2. Lf. Common Carotid a.: enters the neck at S-C joint 3. Lf. Subclavian a.: most post. branch loops over 1st rib upper limb

Nerves in Mediastinum: Vagus & Phrenic

Vagus Nerve
CN X (parasympathetic)
Rt. Vagus: - Lat. to the trachea - Medial to azygos - Post. to root of the Rt. lung - Join esophagus: esophageal opening (Post.)

Gives Rt. Recurrent laryngeal n. that loops around subclavian a.

Left Vagus
- Descends between lf. Cc & lf. Subc. - ant. & Lf. to aortic arch Lf. Recureent laryngeal n. (read your textbook) - Post. to lung root - Join esophagus: esophageal opening (ant.)

Phrenic Nerve
C3, 4, 5 Motor: Sole motor to diaphragm Sensory: Sensory to central part of diaphragm Pericardium Parietal pleura (mediastinal & ?) Peritoneum (diaphragmatic)

Rt. Phrenic
Descends lat. to brachiocephalic & SVC
Ant. to root of Rt. Lung Rt. Side of pericardium Rt. to IVC: caval opening

Left Phrenic
Enters lf. To subclavian a. Lat. To vagus n (X) Ant. to root of Lf. Lung

Trachea
Fibrocartilaginous tube (C6-sternal angle) In deep inspiration it reaches the level of ? U-shaped bars of hyaline catilage & smooth muscle (trachialis) Rt. bronchus: Wider, shorter & more vertical Lf. Bronchus: Narrower, longer & more horizontal Relations of lf. bronchus?
Inf. To ?, ant. To ??

Tracheal Relations
Anterior:
Lf. Brachiocephalic v. & manubrium

Posterior:
esophagus & recurrent laryngeal n.

Right:
Rt. Vagus n. & Azygos v. (just inf.)

Left:
Aortic arch, Lf. CC & Subclav. A & Lf. Vagus n.