Mediastinum,

I. Mediastinum is an interpleural space (area between the

pleural cavities) in the thorax and is bounded laterally by the
pleural cavities, anteriorly by the sternum, and posteriorly by
the vertebral column (does not contain the lungs). It extends
from superior thoracic aperture to diaphragm inferiorly.
It contains all the thoracic viscera and structures except
lungs.
Consists of the superior mediastinum above the pericardium
and the three lower divisions: anterior, middle, and posterior.
. !uperior mediastinum
". nterior mediastinum (in front of pericardium)
C. Middle mediastinum (#he middle mediastinum includes the
pericardium, heart, and roots of its great vessels (ascending
aorta, pulmonary trun$, and !%C) passing to and from the heart).
&. 'osterior mediastinum (posterior to pericardium)
Contents of mediastinum: (eart, the great vessels of the
heart, esophagus, trachea, phrenic nerve, cardiac nerve, thoracic
duct, thymus, and lymph nodes of the central chest.
Pericardium and Heart
I. 'ericardium
Is a )broserous sac that encloses the heart * beginning of
great vessels
Is composed of the )brous pericardium and serous
pericardium.
. +ibrous pericardium ,,, the outer most layer, its internal surface
of it is lined by glistering serous memebrane, the parietal layer of
serous pericardium. #his layer is re-ected onto the heart at the
great vessels (aorta, pulmonary trun$ and veins, and superior and
inferior venae cavae) as the visceral layer of serous pericardium.
#he serous pericardium is composed mainly of mesothelium
(that.s secrets the pericardial -uid), a single layer of -attened
cells forming an epithelium that lines both the internal surface of
the )brous pericardium and the external surface of the heart. #he
)brous pericardium protects the heart against sudden over )lling
because it is so unyielding.
C. 'ericardial cavity
Is a potential space between the visceral layer of the serous
pericardium (epicardium) and the parietal layer of the serous
pericardium. It contains thin )lm of -uid that enables the
heart to move and beat in a frictionless environment.
/erve supply to pericardium: 'hrenic nerves
(C01C2), primary source of sensory )bers3 pain sensations
conveyed by these nerves are commonly referred to the s$in (C01
C2 dermatomes) of the Ipsilateral supraclavicular region (top of
the shoulder of the same side).
!ympathetic trun$s are vasomotor.
pplied natomy: Pericarditis, Pericardial Rub, and
Pericardial Efusion
#he pericardium may be involved in several disease processes.
In-ammation of the pericardium (peri,carditis) usually causes
chest pain. It may also ma$e the serous pericardium rough.
4sually the smooth opposing layers of serous pericardium ma$e
no detectable sound during auscultation. If there is pericarditis,
friction of the roughened surfaces may sound li$e the rustle of sil$
when listening with a stethoscope over the left sternal border and
upper ribs (pericardial friction rub). !ome in-ammatory diseases
produce pericardial e5usion
(passage of -uid from pericardial capillaries into the pericardial
cavity, or an accumulation of pus). s a result, the heart becomes
compressed (unable to expand and )ll fully) and ine5ective.
Cardiac Tamponade
#he )brous pericardium is a tough, inelastic, closed sac that
contains the heart, normally the only occupant other than a thin
lubricating layer of pericardial-uid. If extensive pericardial
e5usion exists, the compromised volume of the sac does not
allow full expansion of the heart, limiting the amount of blood the
heart can receive, which in turn reduces cardiac output, which is a
potentially lethal condition.
Pericardiocentesis: sternal approach or subxiphoid
approach
&rainage of excess -uid from the pericardial cavity,
pericardiocentesis, is usually necessary to relieve cardiac
tamponade. &uring pericardiocentesis needle is passed through
the left 2
th
intercostal space immediately ad6acent to the sternum,
because the cardiac notch of the left lung leaves the pericardial
sac exposed at this site. (ence, there is no danger of entering
into the pleural cavity.
#he needle should be $ept close to the sternal margin to avoid
danger to the internal thoracic vessels, which lie 7cm or more
lateral to the sternal margin or more lateral to sternal margin. #he
edge of the sternum is located with the tip of the needle before
plunging into the pericardial sac.
(#he parasternal route is commonly used for intracardiac
in6ections also)
In subxiphoid approach: the needle is passed superoposteriorly
through the left cost,xiphoid angle because the parietal pleura
does not extend beyond the costal margin at this site. If the
needle is not angled properly, the diaphragm and liver might be
punctured.

Heart:
#he wall of each chamber of the heart consists of three layers
from super)cial to deep
8picardium, a thin external layer (mesothelium) formed by the
visceral layer of serous pericardium.
Myocardium, a thic$ middle layer composed of cardiac
muscle.
8ndocardium, a thin internal layer (endothelium and
subendothelial connective tissue) or lining membrane of the
heart that also covers its valves.
#he muscle )bers are anchored to the )brous s$eleton of the
heart (
#he )brous framewor$ of dense collagen forms four )brous rings,
which surround the ori)ces of the valves, right and left )brous
trigones (formed by connecting the rings, and the membranous
parts of the interatrial and interventricular septa). #he )brous
s$eleton of the heart:
9eep the ori)ces of the % and semilunar valves patent and
from being overly distended by the volume of blood pumping
through them.
'rovides attachments for the lea-ets and cusps of the
valves.
'rovides attachment for the myocardium, +orms an electrical
:insulator; by separating the myenterically conducted
impulses of the atria and ventricles so that they contract
independently and by surrounding and providing passage for
the initial part of the % bundle (part of the conducting
system of the heart).
Orientation of the Heart
#he heart is related anteriorly to the sternum, costal cartilages,
and the medial ends of the 0rd12th ribs on the left side.
#he heart and pericardial sac are situated obli<uely, about two
thirds to the left and one third to the right of the median plane.
#he heart is shaped li$e a tipped,over, three,sided pyramid with
an apex, base, four surfaces * four borders.
The apex of the heart
Is directed anteriorly and to the left and is formed by the
inferolateral part of the left ventricle.
Is located at left 2th intercostal space in adults, usually = cm
from the median plane.
Is where the sounds of mitral valve closure are maximal (apex
beat)3 the apex underlies the site where the heartbeat may be
auscultated on the thoracic wall.
uscultation
#he process of listening to sounds that are produced by
internal organs in the body. &irect auscultation uses the ear
alone, such as when listening to the grating of a moving 6oint.
Indirect auscultation involves the use of a stethoscope to
amplify the sounds from within the body, li$e a heartbeat or
lung sounds.
The base of the heart
Is the heart>s posterior aspect.
Is formed mainly by the left atrium, with a lesser contribution
by the right atrium.
+aces posteriorly toward the bodies of vertebrae #?1#=, and is
separated from them by, esophagus, and aorta.
@eceives the pulmonary veins on the right and left sides of its
left atrial portion and the superior and inferior venae cavae at
the superior and inferior ends of its right atrial portion.
The four surfaces of the heart are the
nterior (sternocostal) surface, formed mainly by the right
ventricle.
&iaphragmatic (inferior) surface, formed mainly by the left
ventricle and partly by the right ventricle.
Aeft pulmonary surface, formed mainly by the left ventricle3 it
forms the cardiac impression of the left lung.
@ight pulmonary surface, formed mainly by the right atrium.
#he four borders of the heart are the
@ight border (slightly convex), formed by the right atrium and
extending between the !%C and the I%C.
Inferior border (nearly horiBontal), formed mainly by the right
ventricle and only slightly by the left ventricle.
Aeft border (obli<ue), formed mainly by the left ventricle and
slightly by the left auricle.
!uperior border, formed by the right and left atria and auricles
Chambers of the Heart
Right trium!
#he right atrium forms the right border of the heart and receives
venous blood from the !%C, I%C, and coronary sinus #he ear,li$e
right auricle is a small, conical muscular pouch that pro6ects from
the right atrium, increasing the capacity of the atrium as it
overlaps the ascending aorta. #he coronary sinus lies in the
posterior part of the coronary groove and receives blood from the
cardiac veins.).
smooth, thin,walled posterior part, on which the !%C, I%C,
and coronary sinus open, bringing poorly oxygenated blood into
the heart.
rough, muscular anterior wall composed of pectinate muscles
(A. musculi pectinati).
right % ori)ce through which the right atrium discharges the
poorly oxygenated blood into the right ventricle.
#he interatrial septum, separating the atria, has an oval,
thumbprint,siBe depression, the oval fossa (A. fossa ovalis), a
remnant of the oval foramen and its valve in the fetus
trial "eptal #efects
Congenital anomalies of the interatrial septumCusually related
to incomplete closure of the oval foramenCare atrial septal
defects (!&s).
Right $entricle!
#he right ventricle forms the largest part of the anterior surface of
the heart, a small part of the diaphragmatic surface, and almost
the entire inferior border of the heart).#he interior of the right
ventricle has irregular muscular elevations called trabeculae
carneae. #he right % ori)ce is surrounded by a )brous ring (part
of the )brous s$eleton of heart) that resists the dilation that might
otherwise result from blood being forced through it at varying
pressures
#he tricuspid valve guards the right % ori)ce. #he bases of the
valve cusps are attached to the )brous ring around the ori)ce.
#endinous cords (A. chordae tendineae) attach to the free edges of
valve cuspsCmuch li$e the cords attached to a parachute.
"ecause the cords are attached to ad6acent sides of two cusps,
they prevent separation of the cusps and their inversion when
tension is applied to the cords throughout ventricular contraction
(systole)Cthat is, the cusps of the tricuspid valve are prevented
from prolapsing (being driven into right atrium) as ventricular
pressure rises. #hus regurgitation of blood (bac$ward -ow of
blood) from the right ventricle into the right atrium is bloc$ed by
the valve cusps.
#he papillary muscles form conical pro6ections with their bases
attached to the ventricular wall and tendinous cords arising from
their apices. #he papillary muscles begin to contract before
contraction of the right ventricle, tightening the tendinous cords
and drawing the cusps together. Contraction is maintained
throughout systole.
#he interventricular septum, composed of membranous and
muscular parts, is a strong, placed partition between the right and
the left ventricles.
Aeft trium: #he left atrium forms most of the base of the heart).
#he pairs of valveless right and left pulmonary veins enter the left
atrium.
#he left auricle forms the superior part of the left border of the
heart.
#he interior of the left atrium has
+our pulmonary veins (two superior and two inferior)
entering its posterior wall.
slightly thic$er wall than that of the right atrium.
left % ori)ce through which the left atrium discharges the
oxygenated blood it receives from the pulmonary veins into
the left ventricle.
Aeft %entricle. #he left ventricle forms the apex of the heart,
nearly all of its left (pulmonary) surface and border, and most of
the diaphragmatic surface
. "ecause arterial pressure is much higher in the systemic than in
the pulmonary circulation, the left ventricle performs more wor$
than the right ventricle, so the
#he interior of the left ventricle has ( double,lea-et mitral valve
that guards the Dalls are two to three times as thic$ as that of the
right ventricle left % ori)ce.
Dalls that are covered with thic$ muscular ridges, trabeculae
carneae, that are )ner and more numerous than those in the
right ventricle.
nterior and posterior papillary muscles that are larger than
those in the right ventricle.
n aortic ori)ce that lies in its right posterosuperior part and is
surrounded by a )brous ring to which the right, posterior, and
left cusps of the aortic valve are attached.
Mitral %al%e. #he mitral valve closes the ori)ce between the left
atrium and the left ventricle.
ortic %al%e. #he aortic valve is shown spread out. It is between
the left ventricle and the ascending aorta.
(eart sounds: are produced by closure of valves and by
turbulence of blood. #wo heart sounds are lub and dub. #he )rst is
due to contraction of ventricles that causes closure of tricuspid
and mitral valves (atrioventricular valves) and second is due to
relaxation of ventricles that causes closure of pulmonary and
aortic valves (semilunar valves).
rterial "uppl& of Heart
#he coronary arteries supply the myocardium and epicardium and
course 6ust deep to the epicardium, normally embedded in fat.
#he right and left coronary arteries arise from the
corresponding aortic sinuses at the proximal part of the
ascending aorta, 6ust superior to the aortic %al%e! #he
endocardium receives oxygen and nutrients directly from the
chambers of the heart.
The right coronar& arter& 'RC) arises from the right aortic
sinus of the ascending aorta and runs in the coronary groove
(sulcus). /ear its origin, the @C usually gives o5 an
ascending sinuatrial '"( nodal branch that supplies the SA
node, (part of the cardiac conducting system). #he @C then
descends in the coronary groove and gives o5 the right
marginal branch, which supplies the right border of the heart as
it runs toward (but does not reach) the apex of the heart. fter
giving o5 this branch, the @C turns to the left and continues in
the coronary groove on the posterior aspect of the heart here its
gives rise to the $ nodal branch, which supplies the AV
node (part of the cardiac conducting system). #he @C then gives
o5 the large posterior I% branch that descends in the posterior I%
groove toward the apex of the heart. #he posterior )$
branch supplies both ventricles and sends
perforating inter%entricular septal branches to the I% septum.
#he terminal (left ventricular) branch of the @C then continues
for a short distance in the coronary groove. #ypically, the @C
supplies:
! node (?EF)
% node (GEF)
@# atrium
Most of @# ventricle
!mall part of A# ventricle
The left coronar& arter& (AC) arises from the left aortic
sinus of the ascending aorta and passes between the left auricle
and the left side of the pulmonary trun$ in the coronary groove. In
approximately HEF of people, the " nodal branch arises from
the circum-ex branch of the AC and ascends on the posterior
surface of the left atrium to the !node. t the left end of the
coronary groove, located 6ust left of the pulmonary trun$, the AC
divides into two branches, an anterior )$ branch (left anterior
descending IA&J branch) and a circum*ex branch! #he
anterior I% branch passes along the I% groove to the apex of the
heart. (ere it turns around the inferior border of the heart and
anastomoses with the posterior I% branch of the right coronary
artery. #he anterior I% branch supplies both ventricles and the I%
septum In many people, the anterior I% artery gives rise to
a lateral 'diagonal( branch, which descends on the anterior
surface of the heart. #he smaller circum*ex branch of the
+C follows the coronary groove around the left border of the
heart to the posterior surface of the heart. #he left marginal
arter&, a branch of the circum-ex branch, follows the left margin
of the heart and supplies the left ventricle. #he circum-ex branch
of the AC terminates in the coronary groove on the posterior
aspect of the heart before reaching the crux, but in about one
third of hearts it continues as the posterior I% branch. T&picall&,
the +C supplies
#he left atrium.
Most of left ventricle.
'art of right ventricle.
Most of I% septum (usually its anterior two thirds), including
the % bundle of conducting tissue, through its perforating I%
septal branches.
#he ! node (in approximately HEF of people).
$enous #rainage of Heart
Most of the cardiac veins carrying deoxygenated blood from heart
drain into coronary sinus and few directly open into right atrium.
#he coronary sinus in turn opens into the right atrium
Conducting "&stem of the Heart
#he conducting system consists of nodal tissue that initiates the
heart beat and coordinates contractions of the four heart
chambers, and highly specialiBed conducting )bers for conducting
them rapidly to the di5erent areas of the heart. #he impulses are
then propagated by the cardiac striated muscle cells so that the
chamber walls contract simultaneously. #he sinuatrial '"(
node is located anterolaterally at the 6unction of the !%C and
right atrium. #he atrioventricular (%) node is a smaller collection
of nodal tissue than the ! node.
#he $ node is located in the posteroinferior region of the
interatrial septum near the opening of the coronary sinus .#he
signal generated by the ! node passes through the walls of the
right atrium, propagated by the cardiac muscle (myogenic
conduction), which transmits the signal rapidly from the ! node
to the % node. #he % node then distributes the signal to the
ventricles through the
% bundle. !ympathetic stimulation speeds up conduction, and
parasympathetic stimulation slows it down. #he % bundle, the
only bridge between the atrial and ventricular myocardium,
passes from the % node through the )brous s$eleton of the heart
and along the membranous part of the I%!. t the 6unction of the
membranous and muscular parts of the I%!, the % bundle divides
into right
and left bundles. #hese branches proceed on each side of the
muscular I%! deep to the endocardium and then ramify into
subendocardial branches
('ur$in6e )bers), which extendinto the walls of the respective
ventricles.
)nner%ation of the Heart
#he heart is supplied by autonomic nerve )bers from super)cial
and deep cardiac plexuses.
#he parasympathetic supply of the heart is from presynaptic
)bers of the vagus nerves (C/ K).
'arasympathetic stimulation slows the heart rate, reduces the
force of the contraction.
"&mpathetic stimulation increases the heart rate and force of
contraction. It also causes dilatation of cardiac arterioles.
Positional Abnormalities of the Heart:
bnormal folding of the embryonic heart may cause the position
of the heart to be completely reversed so that the apex is
misplaced to the right instead of the leftCdextrocardia. #his
congenital anomaly is the most common positional abnormality of
the heart, but it is still relatively uncommon. &extrocardia is
associated with mirror image positioning of the great vessels and
arch of the aorta. #his anomaly may be part of a general
transposition of the thoracic and abdominal viscera (situs
inversus), or the trans,position may a5ect only the heart (isolated
dextrocardia). In dextrocardia with situs inversus, the incidence of
accompanying cardiac defects is low, and the heart usually
functions normally.
Coronar& rter& #isease or Coronar& Heart #isease
Coronary artery disease (C&) is one of the leading causes of
death. It has many causes, all of which result in a reduced blood
supply to the vital myocardial tissue.
M,OCR#)+ )-.RCT)O-
Dith sudden occlusion of a ma6or artery by an embolus, the
region of myocardium supplied by the occluded vessel becomes
infracted (rendered virtually blood,less) and undergoes necrosis
and this part of the heart stop functioning called heart attac$
(pathological tissue death). #he three most common sites of
coronary artery occlusion and the percentage of occlusions
involving each artery are the: 7.the most common is nterior I%
(A&) branch of the AC (HE12EF)).n area of myocardium that
has undergone necrosis constitutes a myocardial infarction (MI).
#he most common cause of ischemic heart disease is coronary
artery insuLciency resulting from atherosclerosis (process,
characteriBed by lipid deposits in the intima (lining layer) of the
coronary arteries). #he clinical features of MI include:
7. sensation of pressure or burning in the chest that last longer
than 0o minutes.
M. 'ain referred to the left arm.
0. /ausea or vomiting, sweating, shortness of breath, and
tachycardia.
Coronar& ngiograph&
4sing coronary angiography, the coronary arteries can be
visualiBed with coronary arteriograms. long, narrow catheter is
passed into the ascending aorta via the femoral artery in the
inguinal region. 4nder -uoroscopic control, the tip of the catheter
is placed 6ust inside the opening of a coronary artery. small
in6ection of radiopa<ue contrast material is made, and cine,
radiographs are ta$en to show the lumen of the artery and its
branches, as well as any stenotic areas that may be present.
Coronar& ngioplast&
In selected patients, surgeons use percutaneous transluminal
coronary angioplasty in which they pass a catheter with a small
in-atable bal,loon attached to its tip into the obstructed coronary
artery. Dhen the catheter reaches the obstruction, the balloon is
in-ated, -attening the atherosclerotic pla<ue against the vessel.s
wall. #he vessel is stretched to increase the siBe of the lumen,
thus improving blood -ow.
Coronar& /&pass 0raft
'atients with obstruction of their coronary circulation and severe
angina (chest pain) may undergo a coronary bypass graft
operation. segment of an artery or vein is connected to the
ascending aorta or to the proximal part of a coronary artery and
then to the coronary artery distal to the stenosis. #he great
saphenous vein is commonly harvested for coronary bypass
surgery.
Cardiac Catheteri1ation
In cardiac catheteriBation, a radiopa<ue catheter is inserted into a
peripheral vein (e.g., the femoralvein) and passed under
-uoroscopic control into the right atrium, right ventricle,
pulmonary trun$, and pulmonary arteries, respectively. 4sing this
techni<ue, intra cardiac pressures can be recorded and blood
samples may be removed. If a radiopa<ue contrast medium is
in6ected, it can be followed through the heart and great vessels
using serially exposed K,ray )lms.
"TRO2E, previously $nown medically as a Cerebro%ascular
accident 'C$(, is the rapidly developing loss of brain function(s)
due to disturbance in the blood supply to the brain.
#hrombi (clots) form on the walls of the left atrium in certain
types of heart disease. If these thrombi detach, or pieces brea$
o5 from them, they pass into the systemic circulation and occlude
peripheral arteries. Ncclusion of an artery supplying the brain
results in a stro$e which may a5ect vision, cognition, or the motor
function of parts of the body previously controlled by the now,
damaged (ischemic) area of the brain.
$al%ular Heart #isease
&isorders involving the valves of the heart disturb the pumping
eLciency of the heart. %alvular heart disease produces either
stenosis (narrowing) or insuf)ciency.
!tenosis is the failure of a valve to open fully, slowing blood -ow
from a chamber.
Insuf)ciency or regurgitation, non the other hand, is failure of the
valve to close completely, usually owing to nodule formation on
(or scarring and contraction of) the cusps so that the edges do not
meet or align. #his allows a variable amount of blood (depending
on the severity) to -ow bac$ into the chamber it was 6ust e6ected
from. "oth stenosis and insuf)ciency result in an increased
wor$load for the heart. @estriction of high,pressure blood -ow
(stenosis) or passage of blood through a narrow opening into a
larger vessel or chamber (stenosis and regurgitation) produces
turbulence. #urbulence sets up eddies
(small whirlpools) that produce vibrations that are audible as
murmurs (on auscultation).
0reat %essels:
#he superior %ena ca%a (!%C) returns blood from all structures
superior to the diaphragm, except the lungs and heart. It passes
inferiorly and ends at the level of the 0rdcostal cartilage, where it
enters the right atrium of the heart. #he !%C lies in the right side
of the superior mediastinum, anterolateral to the trachea and
posterolateral to the ascending aorta.
#he ascending aorta, approximately M.2 cm in diameter, begins
at the aortic ori)ce. Its only branches are the coronaryarteries,
arising from the aortic sinuses. #he ascending aorta is
intrapericardial.
#he arch of the aorta (aortic arch), the curved continuation of the
ascending aorta begins posterior to the Mnd right sternocostal
(!C) 6oint at the level of the sternal angle. It arches superiorly,
pos,teriorly and to the left, and then inferiorly. #he arch ascends
anterior to the right pulmonary artery and the bifurcation of the
trachea, reaching its apex at the left side of the trachea and
esophagus as it passes over the root of the left lung. #he arch
descends posterior to the left root of the lung beside the #H
vertebra. #he arch ends by becoming the thoracic (descending)
aorta posterior to the Mnd left sternocostal 6oint.
#he usual branches of the arch are the brachiocephalic trun$, left
common carotid artery, and left subclavian artery. #he
brachiocephalic trun$, the )rst and largest branch of the arch of
the aorta, it divides into the right common carotid and right
subclavian arteries.
/ranches of thoracic aorta: named branches to respecti%e
thoracic %iscera
Th&mus
#he thymus, a lymphoid organ, is located in the lower part of the
nec$ and the anterior part of the superior mediastinum. It lies
posterior to the manubrium of the sternum and extends into the
anterior mediastinum.
-er%es of the Thorax
-er%e Origin #istribution
%agus (C/
K)
from medulla of
brainstem
'ulmonary plexus, esophageal
plexus, and cardiac plexus
'hrenic C01C2 Central portion of diaphragm
Intercostal
s (7177)
#71#77 Muscles in and s$in over intercostal
space3 lower nerves supply muscles
and s$in of anterolateral abdominal
wall
!ubcostal #7M nerve bdominal wall and s$in of gluteal
region
@ecurrent
laryngeal
%agus nerve Intrinsic muscles of larynx)3
Cardiac
plexus
Cervical and
cardiac branches
of vagus nerve
and sympathetic
trun$
Impulses pass to ! node3
parasympathetic )bers slow rate3
reduce force of heartbeat, and
constrict coronary arteries3
sympathetic )bers have opposite
e5ect
'ulmonary
plexus
%agus nerve and
sympathetic trun$
'arasympathetic )bers constrict
bronchioles3 sympathetic )bers
dilate them
8sophage
al plexus
%agus nerve,
sympathetic
ganglia and
greater splanchnic
nerve
%agal and sympathetic )bers to
smooth muscle and glands of
inferior two thirds of esophagus
Trachea
In tetrapod anatomy the trachea, or 3indpipe, is a tube that
connects the pharynx or larynx to the lungs, allowing the passage
of air. It is lined with columnar epithelium cells with goblet
cells which produce mucus. #his mucus lines the cells of the
trachea to trap inhaled foreign particles which the cilia then waft
upwards towards the larynx and then the pharynx where it can
either be swallowed into the stomach or expelled as phlegm.
#he length is about 7E to 7? centimetres (0.= to ?.0 in). It
commences at the larynx, level with the sixth cervical vertebrae,
and bifurcates into the primary bronchi at the vertebral level
of #HO#2.
#here are about )fteen to twenty incomplete C,
shaped cartilaginous rings which reinforce the anterior and lateral
sides of the trachea to protect and maintain the airway.
#he trachealis muscle connects the ends of the incomplete rings,
and contracts during coughing, reducing the siBe of the lumen of
the trachea to increase the air -ow rate. #he esophagus lies
posteriorly to the trachea. #he cartilaginous rings are incomplete
to allow the trachea to collapse slightly so that food can pass
down the esophagus. -ap,li$e epiglottis closes the opening to
the larynx during swallowing to prevent swallowed matter from
entering the trachea.
#horacic orta
natomy Nf Carina: it is a cartilaginous ridge within
the trachea that runs anteroposteriorly between the two
primary bronchi at the site of the tracheal bifurcation at the lower
end of the trachea (usually at the level of the Hth to 2th thoracic
vertebrae, which is in line with the ngle of Aouis).
#he mucous membrane of the carina is the most sensitive area of
the trachea and larynx for triggering a cough re-ex.
Esophagus
#he esophagus is a )bromuscular tube that extends from the
pharynx to the stomach. It is usually -attened anteroposteriorly
#he esophagus enters the superior mediastinum between the
trachea and the vertebral column, where it lies anterior to the
bodies of vertebrae #71#H. #he thoracic duct usually lies on the
left side of the esophagus). 8sophagus inclines to the left as it
approaches and passes through the esophageal hiatus in the
diaphragm.
Thoracic duct
Aocation
In the posterior mediastinum, the thoracic duct lies on the bodies
of the inferior seven thoracic vertebrae.
#he thoracic duct conveys most lymph of the body to the venous
system
In human anatomy, the thoracic duct (a$a left lymphatic duct) is
an important part of the lymphatic systemCit is the largest
lymphatic vessel in the body.
It collects most of the lymph in the body (except that from the
right arm and the right side of the chest, nec$ and head, and
lower left lobe of the lung, which is collected by the right
lymphatic duct) and drains into the systemic (blood) circulation at
the left brachiocephalic vein, right between where the left
subclavian vein and left internal 6ugular connection.
IIn adults, the thoracic duct is typically 0G,H2cm in length and an
average diameter of about 2mm. It usually starts from the level of
the second lumbar vertebra and extends to the root of the nec$.
It originates in the abdomen from the con-uence of the right and
left lumbar trun$ and the intestinal trun$, forming a signi)cant
pathway upward called the cisterna chyli, from here the duct
courses vertically along the aortic ori)ce of diaphragm to enter
the thoracic cavity and furthers ascends behind the esophagus,
then crosses behind the esophagus from right to left side at the
level of #2 vertebrae, thereafter it ascends up along the left
border of the esophagus until it reaches the level of the
transverse processes of CP vertebrae. t the root of the nec$ it
empties into the 6unction of the left subclavian vein and
left 6ugular vein, (called venous angle) below the clavicle, near
the shoulders.
#iaphragm
#he diaphragm functions in breathing. &uring inhalation, the
diaphragm contracts, thus enlarging the thoracic cavity (the
external intercostal muscles also participate in this enlargement).
#his reduces intra,thoracic pressure: In other words, enlarging the
cavity creates suction that draws air into the lungs. Dhen the
diaphragm relaxes, air is exhaled by elastic recoil of the lung and
the tissues lining the thoracic cavity in con6unction with the
abdominal muscles, which act as an antagonist paired with the
diaphragm>s contraction.
#he diaphragm is also involved in non,respiratory functions,
helping to expel vomit, faeces, and urine from the body by
increasing intra,abdominal pressure, and preventing acid re-ux
by exerting pressure on the esophagus as it passes through the
esophageal hiatus.
In some non,human animals, the diaphragm is not crucial for
breathing3 a cow, for instance, can survive fairly asymptomatically
with diaphragmatic paralysis as long as no massive aerobic
metabolic demands are made of her.
natom&
#he diaphragm is a dome,shaped musculo)brous septum that
separates the thoracic from the abdominal cavity, its convex
upper surface forming the -oor of the thorax, and its concave
under surface the roof of the abdomen .Its peripheral part
consists of muscular )bers that ta$e origin from the
circumference of the inferior thoracic aperture and converge to be
inserted into a central tendon.
#he muscular )bers may be grouped according to their origins
into three parts:
Part Origin
stern
al
#wo muscular slips from the bac$ of the xiphoid process.
costal
#he inner surfaces of the cartilages and ad6acent portions
of the lower six ribs on either side,
lumb
ar
lumbar vertebrae.
)nner%ation
#he diaphragm is innervated by the phrenic nerve.
)-"ERT)O-
ll the )bers of diaphragm is converted into a common central
tendon
#he central tendon of the diaphragm is a thin but strong
aponeurosis situated near the center of the vault formed by the
muscle, but somewhat closer to the front than to the bac$ of the
thorax,
Openings in the #iaphragm
Inferior view of the human diaphragm, showing openings
#he diaphragm is pierced by a series of apertures to permit of the
passage of structures between the thorax and abdomen. #hree
large openings C the aortic, the esophageal, and the vena cava
C and a series of smaller ones are described.
opening
le%
el
structures
caval opening #G inferior vena cava,
esophageal
hiatus
#7E esophagus,
aortic hiatus #7M
the aorta, the aBygos vein, and the
thoracic duct
commonly used mnemonic to remember the level of the
diaphragmatic apertures is this: Mnemonic
ortic hiatus Q 7M letters Q #7M
Nesophagus Q 7E letters Q #7E
%ena cava Q G letters Q #G
(iccups are involuntary intermittent sudden contractions of the
diaphragm.