1. The document describes the anatomy of the thorax, including boundaries, layers, and contents of the thoracic wall, mediastinum, and pleural spaces. 2. Key structures discussed include the lungs, heart, great vessels, trachea, esophagus, thymus, lymph nodes, and nerves of the thoracic cavity and mediastinum. 3. Clinical conditions involving the pleura and mediastinum are also summarized, such as pneumothorax, mediastinitis, and superior mediastinal syndrome.

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3. Thorax - boundaries
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4. Plane of Inlet
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45°

5. Superior Thoracic Aperture
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6. Suprapleural membrane/ Sibson’s fascia
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7. 7
Suprapleural membrane: Relations

8. Inf thoracic aperture-Diaphragm- ant view
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9. 9
Layers in thoracic wall

10. Thoracic cavity
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11. Pleura: Layers
1. Visceral
2.Parietal
• Cervical
• Costal
• Diaphragmatic
• Mediastinal
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12. Parietal pleura
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13. Pleura: Parts
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14. PLEURAL REFLECTIONS
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15. Surface marking
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Surface marking

17. Pulmonary ligament
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18. Pleural recesses
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19. 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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20. Mediastinum
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Mediastinum: Boundaries & SUBDIVISIONS

22. 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

23. Superior Mediastinum - contents
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24. Superior Mediastinum: Contents
• Muscles:
•Sternohyoid
•Sternothyroid
•Longus colli
• Thymus: in childhood & puberty
• Trachea & Esophagus
• Thoracic Duct 25

25. • 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 26

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27. Anterior Mediastinum: Contents
• Thymus (Children)
• Sternopericardial
ligaments
• Internal thoracic
artery & branches
• Lymphatics & Lymph
nodes
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28. 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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29. • Nerves: Phrenic, Deep cardiac plexus
• Bifurcation of Trachea with two principal
bronchi
• Tracheobronchial lymph nodes
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Posterior
Mediastinum
Contents

31. Posterior Mediastinum: Contents
• Esophagus
• Thoracic duct
• Arteries : Descending Aorta with its
brs
• Veins: Azygos, Hemiazygos &
Accessory hemiazygos
• Nerves: Vagus & Splanchnic nerves
• Lymph nodes: Posterior mediastinal32

32. Applied Anatomy
• Pleuritis/pleurisy
• Pleural effusion / hydrothorax
• Haemothorax
• Empyema
• Referred pain - from diaphragmatic pleura
• Pleural tapping
• Pneumothorax – open, closed, tension
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33. 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 34

34. Needle decompression 2nd ICS in MCLNeedle decompression 2nd ICS in MCL
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35. Applied AnatomyApplied Anatomy
• Mediastinitis
• Mediastinoscopy
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Mediastinoscopy

37. 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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38. • Superior Mediastinal syndrome
obstruction to SVC
•Engorgement of veins
•Dyspnea
•Dysphagia
•Hoarseness of voice
• Mediastinal shift
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