Clinanatomy mediastinum Clinanatomy mediastinum.ppt

Clinanatomy mediastinum

1. L/O/G/O
subject:
Introduction to clinical
anatomy of vessels and
nerves. Clinical anatomy
vessels and nerves
of the chest and
mediastinum

Department of anatomy, histology
and normal physiology

2. Clinical anatomy of vessels
and nerves
Discipline study is 2
credits (60 hours)
2-year, 4-semester
Department of anatomy, histology and normal physiology

3. Clinical anatomy of vessels
and nerves
The purpose of the discipline:
the acquisition of a comprehensive
understanding of the relationship
between blood vessels, nerves and
surrounding tissues, as well as the
formation of general medical
competence in matters of the structural
organization of the basic processes of
vital activity of the body.
Department of anatomy, histology and normal physiology

4. Clinical anatomy of vessels
and nerves
1
2
3
To study data on the structure of the vessels and
nerves of the organs of the human body in order to
understand the basics of their functioning, their
anatomical and topographical relationships;
To form in students the ability to correctly name the
vessels and nerves of a person and their parts;
Consider the skills of applying knowledge to explain
the causes of certain symptoms and correct
assessment of the morphological changes detected
using modern instrumental methods of diagnosis
Objectives of the discipline:

5. Clinical anatomy of vessels
and nerves
Content of the curriculum sections:
Didactic units:
• Clinical anatomy of the vessels and nerves
of the head and neck;
• Clinical anatomy of the vessels and nerves
of the upper limb;
• Clinical anatomy of the vessels and nerves
of the chest, abdomen and pelvis;
•Clinical anatomy of the vessels and nerves
of the lower limb

6. Clinical anatomy of vessels
and nerves
As a result of studying the discipline, the
student must:
KNOW:
•structure, functions,
topography and development
of vessels and nerves, their
branches and areas of blood
supply and innervation, taking
into account individual, sex
and age characteristics;•
anatomical terms in the
sections “Vascular system”
and “Peripheral nervous
system” in accordance with
the International Anatomical
Nomenclature.
BE ABLE TO
accurately and accurately
determine the details of the
structure, the course and
location of the vessels, their
projection on the surface of
the body, the location of the
pulsation, the area of
​​the
blood supply;• accurately and
accurately determine the
details of the structure of the
nerve plexuses and nerves,
their projection on the surface
of the body, the area of
​​
innervation;
•the skill of working with
anatomical preparations of
vessels and nerves,
determining their location in
the body, correctly describing
the areas of blood supply and
innervation using anatomical
terms;the skill of using
reference anatomical
literature, as well as online
resources on clinical anatomy.
OWN:

7. Clinical anatomy of vessels
and nerves
Lectures
Practical
classes
Types of
educational
work:
Reporting
EXAM

8. L/O/G/O
Lecturer: Mirlan Nuruev
Clinical anatomy
vessels and nerves
of the chest and
mediastinum

9. Contents:
1.General anatomy of the chest and mediastinum
2. Main neurovascular bundles
3. Arteries of the chest and mediastinum

4. Veins, lymph vessels and nodes of the chest and
mediastinum
5. Nerves of the chest and mediastinum
6. Clinical aspects

10. General anatomy of the chest
The chest, properly called the
thorax, is the superior part of the
trunk located between the neck and
abdomen. It consists of several
components:
•Thoracic wall
•Several cavities
•Neurovasculature and lymphatics
•Internal organs
•Breasts

11. General anatomy of the chest

12. General anatomy of the chest
There are five muscles that make up
the thoracic cage; the intercostals
(external, internal and innermost),
subcostals, and transversus thoracis.
These muscles act to change the  volume
of the thoracic cavity during respiration.
There are some other muscles that
do not comprise the thoracic wall, but
do attach to it. These include the
pectoralis major, minor, serratus anterior
and the scalene muscles.

13. General anatomy of the chest
The diaphragm is a double-domed
musculotendinous sheet, located at the
inferior-most aspect of the rib cage. It serves
two main functions:
Separates the thoracic cavity from the
abdominal cavity (the word diaphragm is
derived from the Greek ‘diáphragma’, meaning
partition).
Undergoes contraction and relaxation,
altering the volume of the thoracic cavity and
the lungs, producing inspiration and
expiration.
In this article, we shall look at the
anatomy of the diaphragm – its attachments,
actions and associated neurovascular
structures.

14. General anatomy of the chest

15. General anatomy of the chest
Female breast anatomy
The breasts are secondary sex charac-
teristics in females and the most prominent
features of the anterior thoracic wall. The
primary function of the  female breast is
milk production following birth. This
function is facilitated by the mammary
glands which produce and squeeze the milk
into the lactiferous ducts. The breast is
attached to the skin of the thorax by
suspensory ligaments (of Cooper) overlying
two major muscles called  pectoralis
major and serratus anterior. 

16. General anatomy of the chest

17. Lymph nodes of the breast

18. Main neurovascular bundles
Arteries
Internal thoracic artery. Usually arises from
the first part of the subclavian artery and
descends directly behind the first six costal
cartilages, just lateral to the sternum.
Gives rise to two anterior intercostal
arteries in each of the upper six intercostal
spaces and terminates at the sixth intercostal
space by dividing into the musculophrenic and
superior epigastric arteries.
Pericardiophrenic artery. Accompanies the
phrenic nerve between the pleura and the
pericardium to the diaphragm.
•Supplies the pleura, pericardium, and diaphragm
(upper surface).

19. Main neurovascular bundles

20. Main neurovascular bundles
Anterior intercostal arteries
Are 12 small arteries , 2 in each of
the upper six intercostal spaces that run
laterally, 1 each at the upper and lower
borders of each space. The upper artery
in each intercostal space anastomoses
with the posterior intercostal artery, and
the lower one joins the collateral branch
of the posterior intercostal artery.
Provide muscular branches to the
intercostal, serratus anterior, and
pectoral muscles

21. Main neurovascular bundles
Musculophrenic artery
Follows the costal arch
on the inner surface of the
costal cartilages.
Gives rise to two anterior
arteries in the seventh, eighth,
and ninth spaces; perforates
the diaphragm; and ends in the
tenth intercostal space, where
it anastomoses with the deep
circumflex iliac artery.
Supplies the
pericardium, diaphragm, and
muscles of the abdominal wall.

22. Superior epigastric artery
Descends on the deep
surface of the rectus
abdominis muscle within
the rectus sheath; supplies
this muscle and
anastomoses with the
inferior epigastric artery.
Supplies the
diaphragm, peritoneum,
and anterior abdominal
wall.

23. Main neurovascular bundles
Veins
Internal thoracic vein.
Is formed by the confluence of the
superior epigastric and musculophrenic
veins, ascends on the medial side of the
artery, receives the upper six anterior
intercostal and pericardiacophrenic veins,
and ends in the brachiocephalic vein.
Thoracoepigastric vein
Is a venous connection between the
lateral thoracic vein and the superficial
epigastric vein.

24. Main neurovascular bundles

25. Main neurovascular bundles
Nerves
Intercostal nerves
Are the anterior primary rami of the first 11
thoracic spinal nerves. The anterior primary ramus
of the twelfth thoracic spinal nerve is the
subcostal nerve , which runs beneath the twelfth
rib.
Run between the internal and innermost
layers of muscles, with the intercostal veins and
arteries above (Veins, Arteries, Nerves [VAN ]).
Are lodged in the costal grooves on the
inferior surface of the ribs.
Give rise to lateral and anterior cutaneous
branches and muscular branches

26. Main neurovascular bundles

27. Main neurovascular bundles

28. Mediastinum
•The mediastinum is a complex of
organs and vascular and nervous
structures located in the chest
cavity and bounded by the anterior
pleurae laterally, behind – the
thoracic spine, the bottom aperture,
the top is directly connected with
the organs of the neck through the
upper aperture of the thorax.
mediastinum

29. Mediastinum
•The international anatomical nomenclature
(PNA) distinguishes 5 divisions of the
mediastinum: upper – from the upper border of
the chest cavity to the tracheal bifurcation (a
conditional horizontal plane drawn through the
angle of the sternum and the intervertebral disk
between the IV and V thoracic vertebrae) and
lower, in which the anterior (between the
sternum and pericardium), middle (between the
anterior and posterior leaves of the pericardium)
and posterior (between the pericardium and the
spine) are distinguished.

30. Mediastinum
•The upper mediastinum includes
the following anatomical
formations: the thymus gland, the
brachiocephalic veins, the superior
Vena cava, the aortic arch and
branches extending from it, the
trachea, esophagus, thoracic duct,
sympathetic trunks, vagus and
diaphragmatic nerves.

31. Mediastinum
•The middle mediastinum contains
the pericardium with the heart
and intrapericardial divisions of
large vessels, bifurcation of the
trachea and main bronchi,
pulmonary arteries and veins,
diaphragmatic nerves and
pericardodiaphragmatic vessels.

32. Mediastinum
•The posterior mediastinum
contains the esophagus,
descending aorta, unpaired and
semi-paired veins, thoracic duct,
sympathetic trunks, internal
nerves, and vagus nerves.

33. Thoracic aorta
•Bronchial bb.
•Oesophageal bb.
•Pericardial bb.
•Mediastinal bb.
•Posterior intercostal aa. (3-9)
–Spinal b
–Dorsal b.
•Subcostal a. (below 12
th
rib)
• Superior phrenic aa.

34. Thoracic aorta

35. AZYGOS VEIN
•Begins as continuation of
right ascending lumbar vein
•Ascending along the right
side of vertebral column
•Joins superior vena cava by
aching above right lung root
at level of T4 to T5
•Receives right posterior
intercostals and subcostal
veins plus some of bronchial,
esophageal and pericardial
veins, and hemiazygos vein
•Tributaries – hemiazygos v.
and accessory hemiazygos
v., which receive most left
posterior intercostals vein
and left bronchial veins

37. THORACIC DUCT
•Begins in front of L1 as a dilated
sac, the cisterna chyli, which
formed by joining of left and
right lumbar trunks and
intestinal trunk
•Enter thoracic cavity by passing
through the aortic hiatus of the
diaphragm and ascends along
on the front of the vertebral
column, between thoracic aorta
and azygos vein
•Travels upward, veering to the
left at the level of T5
•At the roof of the neck, it turns
laterally and arches forwards
and descends to enter the left
venous angle

38. •Just before termination, it
receives the left jugular,
subclavian and
bronchomediastinal trunks
•Drains lymph from lower
limbs, pelvic cavity,
abdominal cavity, left side
of thorax, and left side of
the head, neck and left
upper limb
RIGHT LYMPHATIC DUCT
•Formed by union of right
jugular, subclavian, and
bronchomediastinal trunks
•Ends by entering the right
venous angle
•Receives lymph from right
half of head, neck, thorax
and right upper limb

40. PHRENIC NERVE
•Descends over scalenus
anterior to enter thorax
•Accompanied by
pericardiophrenic vessels
and passes anterior to lung
roots between mediastinal
pleura and pericardium to
supply motor and sensory
innervation to diaphragm
•Sensory fibers supply to
pleurae, pericardium and
peritoneum of diaphragm;
usually right phrenic nerve
may be distributed on live,
gallbladder and biliary
system.

41. LEFT VAGUS NERVE
•Enter thoracic inlet between
left common carotid and left
subclavian arteries, posterior
to left brachiocephalic vein
•Crosses aortic arch where left
recurrent laryngeal nerve
branches off
•Passes posterior to left lung
root
•Forms anterior esophageal
plexus
•Forms anterior vagal trunk at
esophageal hiatus where it
leaves thorax and passes into
abdominal cavity , then
divides into anterior gastric
and hepatic branches

42. RIGHT VAGUS NERVE
•Enter thoracic inlet on right
side of trachea
•Travels downward posterior
to right brachiocephalic vein
and superior vena cava
•Passes posterior to right lung
root
•Forms posterior esophageal
plexus
•Forms posterior vagal trunk
at esophageal hiatus where it
leaves thorax and passes into
abdominal cavity, then
divides into posterior gastric
and celiac branches

43. THORACIC SYMPATHETIC
TRUNK
•Branches of sympathetic
trunk to thoracic plexuses
•Greater splanchnic nerve -
formed by preganglionic fibers
from T5~T9 ganglia, and relay
in celiac ganglion.
•Lesser splanchnic nerve -
formed by preganglionic fibers
from T10~T12 ganglia, and
relay in aorticorenal ganglion.
•The postganglionic fibers
supply the liver, spleen,
kidney and alimentary tract
as far as the left colic flexure.

44. Thanks!!!