Mediastinum.pdf mediastinum pdf boot camp

Mediastinum

1. TABLE OF CONTENTS
1.Organization of the Mediastinum
2.Arteries and Blood Supply
3.Veins and Venous Drainage
4.Lymphatics
5.Nerves and Innervations
6.Practice Questions
Mediastinum

2. OUTLINE
1.Arteries
●Aortic arch
○Brachiocephalic trunk
■Right common carotid
■Right subclavian
○Left common carotid
○Left subclavian
●Descending aorta
○Posterior intercostal
2.Veins
●Brachiocephalic
●Azygos
●Posterior intercostal
●Hemiazygos
●Accessory hemiazygos
Mediastinum
REVIEW
3.Nerves
●Left recurrent laryngeal
●Esophageal plexus
●Vagus
●Sympathetic trunk
●Sympathetic chain (paravertebral)
ganglia
●White and gray rami
communicantes
●Greater splanchnic
●Intercostal
4.Miscellaneous
●Esophagus
●Ligamentum arteriosum
●Trachea
●Cartilaginous tracheal rings
●Bronchi
●Thoracic duct

3. Mediastinum Bootcamp.com
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4. Mediastinum Bootcamp.com
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5. Mediastinum Bootcamp.com
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6. Mediastinum Bootcamp.com
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7. Mediastinum Bootcamp.com
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9. Mediastinum Bootcamp.com
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11. Mediastinum Bootcamp.com
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12. 1.Lymph Nodes of the Mediastinum
●Superior phrenic
●Posterior intercostal
●Posterior mediastinal
●Parasternal
●Brachiocephalic
●Paratracheal
2.Thoracic Duct
●Location and path of the thoracic duct
3.Case Study

OUTLINE
Lymphatics of
the
Mediastinum
REVIEW

13. Mediastinum Bootcamp.com
Mediastinal Lymph Nodes
1.Superior phrenic
2.Posterior intercostal
3.Posterior mediastinal
4.Parasternal
5.Brachiocephalic

14. Mediastinum Bootcamp.com
Mediastinal Lymph Nodes
1.Inferior tracheobronchial
2.Superior tracheobronchial
3.Brachiocephalic
4.Paratracheal
Right
bronchomediastinal
trunk
Right lymphatic duct
Internal jugular
vein
Thoracic duct
Left
bronchomediastinal
trunk
Subclavian vein

15. Mediastinum Bootcamp.com
Thoracic Duct

16. Mediastinum Bootcamp.com
Clinical Application
●A patient presents to your clinic with the following
symptoms:
○Dyspnea
○Orthopnea
○Non-productive cough
●A CXR is ordered
○What is abnormal about this image?
○What is on your differential diagnosis?

17. Mediastinum Bootcamp.com
Clinical Application
●What is abnormal about this image?
●What is on your differential diagnosis?
Normal Abnormal

18. Mediastinum Bootcamp.com
Clinical Application
●The patient had esophageal surgery two weeks ago
●You perform a thoracentesis and the fluid appears
milky
1.What is this fluid?
2.What was damaged to cause this to happen?
3.What is the treatment for this condition?

19. Mediastinum Bootcamp.com
Clinical Application
●The patient had esophageal surgery two weeks ago
●You perform a thoracentesis and the fluid appears
milky
1.What is this fluid?
2.What was damaged to cause this to happen?
3.What is the treatment for this condition?

20. References
1.Slide 2&3: Created with BioRender.com
2.Slide 5&6: Matani S, Pierce JR, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>,
via Wikimedia Commons
3.Slide 6: Stillwaterising, CC0, via Wikimedia Commons
4.Slide 7: James Heilman, MD, CC BY-SA 4.0
<https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
Mediastinum Bootcamp.com

21. Mediastinum Bootcamp.com
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22. Mediastinum Bootcamp.com
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INTERCOSTALNERVES
ORIGIN
ANTERIORRAMIOFTITH
DIVISIONSBRANCHES
ANTERIORELATERALCUTANEOUSNN
SENSORYFUNCTION
TITH
SENSORYDERMATOMES
MOTORFUNCTION
EXTERNALINTERCOSTAL
INTERNALINTERCOSTAL
INNERMOSTINTERCOSTAL
TRANSVERSUSTHORACIS
LESION

23. Mediastinum Bootcamp.com
SYMPATHETICNERVOUSSYSTEM PARASYMPATHETIC NERVOUSSYSTEM
FIGHTORFLIGHT RESTANDDIGEST
INCREASE HEARTRATE
DECREASE
VASOCONSTRICTION VEINS
VASODILATION
DILATION BRONCHIALSMOOTHMUSCLE CONTRACTION
DECREASE GIMOTILITY INCREASE
GLYCOGENOLYSIS GLYCOGENORGLUCOSE GLYCOGENSYNTHESIS
DECREASE URINARYOUTPUT INCREASE
CONTRACTS
SPHINCTEROFBLADDER RELAXATION
INCREASE SWEATGLANDSECRETIONS DECREASE

24. Mediastinum Bootcamp.com
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25. Mediastinum Bootcamp.com
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26. Mediastinum Bootcamp.com
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27. Mediastinum Bootcamp.com
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28. Mediastinum Bootcamp.com
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29. Mediastinum Bootcamp.com
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30. Mediastinum Bootcamp.com
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31. Mediastinum Bootcamp.com
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32. Mediastinum Bootcamp.com
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WHATWOULDHAPPEN
IFTHIS
NERVEWASLESIONED

33. Mediastinum Bootcamp.com
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34. Mediastinum Bootcamp.com
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35. Mediastinum Bootcamp.com
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WH8R86O8STH8THOR1-I-6U-TORI_IN1T8
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36. Mediastinum Bootcamp.com
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37. OUTLINE
1.Arteries
●Aortic arch
○Brachiocephalic trunk
■Right common carotid
■Right subclavian
○Left common carotid
○Left subclavian
●Descending aorta
○Posterior intercostal
2.Veins
●Brachiocephalic
●Azygos
●Posterior intercostal
●Hemiazygos
●Accessory hemiazygos
Mediastinum
Review Questions
•Can you draw the branches coming off of the aortic arch?•Can you identify the
differences between the azygos, hemiazygos, and accessory hemiazygos veins?
REVIEW
3.Nerves
●Left recurrent laryngeal
●Esophageal plexus
●Vagus
●Sympathetic trunk
●Sympathetic chain (paravertebral)
ganglia
●White and gray rami
communicantes
●Greater splanchnic
●Intercostal
4.Miscellaneous
●Esophagus
●Ligamentum arteriosum
●Trachea
●Cartilaginous tracheal rings
●Bronchi
●Thoracic duct
ARETHEPREGANGLIONICNERVEFIBERSIN
WHITECOMMUNICANS SYMPATHETICOR
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WHITERAMI
COMMUNICANSe
n
GRAYRAMI
COMMUNICANS
SYMPATHETICCHAINGANGLIA

38. Mediastinum Bootcamp.com
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WHITECOMMUNICANS SYMPATHETICOR
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