Posterior Mediastinum

Boundaries
Anterior: Pericardium & diaphragm Posterior: T5 T12 Superior: ??imaginary line of sternal angle Inferior: diaphragm

Contents
1. Descending thoracic aorta 2. Azygos & hemiazygos veins

3. Thoracic duct
4. Sympathetic trunk 5. Esophagus

Thoracic Aorta
Starts left to inf. T4 body As it descends shifts to midline Terminates: ant. to T12 body (opening??aortic opening) Pass posterior to lf. Lung root

Branches
1. Bronchial a. (3): trachea, bronchi & lungs
2. Esopahgeal a. (which 1/3 ?middle) 3. Pericardial a. 4. Superior phrenic a. 5. Posterior intercostal a.: 9 pairs (3rd-11th) 6. ??

Azygos System of Veins

(G, unpaired) Drains Post. thoracoabdominal walls Exhibits Many variations 3 veins: Azygos (Rt.)

Inf. hemiazygos (Lf.)

Sup. (accessory) hemiazygos (Lf.)

Azygos Vein
Formed by: ???

Rt. To aorta
Aortic hiatus (Rt. T12) T5 Arches over the root of Rt. lung Opens into post. SVC (T5)

Inferior Hemiazygos Vein

On Left side
From T12 T8

Drains: Lower Lf. Post. intercostal vein (9th-11th, & subcostal) At T8: Turns to Rt. azygos vein

Accessory Hemiazygos
On left side (superiorly) Receives: 4th-8th Lf. Post. intercostal v. At T 7: Turns to Rt. azygos vein

Azygos system provides alternative pathway between SVC & IVC

Lymphatic Thoracic Duct

Thoracic Duct
The largest lymph duct in the body

Begins in abdomen as a dilated sac (cisterna chyli)

Aortic Hiatus (between aorta & azygos) Lf. Brachiocephalic Vein (Jxn: Int. jugular & Subclavian)

Drains lymph from all body except:

Rt. Thorax, Rt. Upper limb, Rt. Head & Neck

Right Lymphatic Duct

Drains: Rt. Thorax Rt. Upper Limb Rt. Head & Neck

Opens: Junx of Rt. Internal jugular & Rt. Subclavian Communicates with thoracic duct

Sympathetic Trunk (Chain)

A chain of ganglia that receives the sympathetic autonomic neurons & distribute them to different body parts Ganglion: a cluster of neuronal cell bodies Sympathetic chain: cervical (3) / thoracic / abdominal / & pelvic

Thoracic Part of Sympathetic Chain

Most lat. Structure in mediastinum Runs on the heads of the ribs Leaves behind medial arcuate lig.

1st thoracic + inf. cervical Stellate ganglion

Esophagus
A tubular structure Begins opposite to C6 as a continuation of the pharynx & ends in the stomach 3 parts: cervical

thoracic (relations)
abdominal

Pass through sup. & post. mediastinum

Then through esophageal opening (which vertebral level? T10)

Thoracic Part Relations

Anterior: Trachea & Lf. Recurrent laryngeal n. (Superior Mediastinum) Posterior: Bodies of thoracic vrtebrae Then Descending aorta Thoracic duct Azygos vein

Right: Mediastinal pleura & azygos vein (as it arches)

Left: Aortic arch & Lf. subclavian a

Superior part of thoracic duct

Vagus nerves join the esophagus & rotate around as it passes through the diaphragm: Rt. Vagus = posterior Lf. Vagus = anterior