1. the Cardiovascular System “Mediastinum”
By: Dr. Nabil A Khouri MD, MsC, Ph.D

2. Bony Thorax (Thoracic Cage)

3. General Structure of thoracic Vertebrae

4. Thoracic Vertebrae

5. Mediastinum
Is the middle compartment of the thoracic cavity which is situated between the right and left mediastinal surface of the lungs covered by pleura.
Boundaries:
Anteriorly, the sternum and the costal cartilages.
Posteriorly, the bodies of 4-12 thoracic vertebrae.
Superiorly, the thoracic inlet.
Inferiorly, the diaphragm.
Laterally (on each side), the mediastinal pleura

6. MEDIASTINUM Inferior mediastium First rib “Thoracic inlet”
Superior boundaries:
Sternal Angle to T4/5
(Inter VD)
Inferior boundaries:
Middle of Xiphoid process to T9
Diaphragm IX

7. 2 3 4 5 6 7 8 9
Body

9. The Location of the Heart within the medastinum

10. The superior mediastinum
Located above the heart and therefore lying behind the manubrium sterni contains:
the great vessels of the heart
                              
Level of Manb. Sterni

11. Contents of sup. mediastinum
The arch of the aorta with its three large branches.
Right and left brachiocephalic veins.
The upper part of the superior vena cava.
The vagus (10th cranial), the phrenic and the left recurrent laryngeal nerves.
The thymus (in children, or some possible remnants in adults).
The trachea.
The esophagus.
Some lymph nodes.

12. A transverse section of the thorax, showing the contents of the Anterior, middle and the posterior mediastinum
Posterior Mediastiunum

13. Content of the posterior mediastinum
artery
thoracic part of the descending aorta
veins
azygos vein
the hemiazygos vein and the accessory hemiazygos vein
nerves
vagus nerve
splanchnic nerves (but not the sympathetic chain[1])
esophagus
thoracic duct
some lymph glands

15. Posterior Right side mediastinum
Azygos Vein
Rt. Prim. Bronch.
Esophagus
Rt. Vagus N
Lymph Nods
Sympathetic plexus
Pulmonary Veins
Pulmonary Arteris
Intercostal arteries and veins
Rt Phrenic N
Br. Ceph. Vein
SVC

16. Left Side Thoracic Cavity
Aorta
4 – Brachio-Ceph. Trunk
5 - Descending Aorta
6 - Left. Main Bronch.
7 - Pulmonary V
8 - Phrinic N and
Pericardio-phrenic A

17. Right
Left

18. Fluid level in Esophagus

19. Anterior mediastinal nodes Lymphoma

20. The Pericardium Outer sac – Fibrous
Inner - Serous, is a double layered sac –(parietal and visceral pericardium
Between the parietal and visceral pericardium is a Small space – the pericardial Cavity
It is filled with pericardial fluid (lubricates and reduces friction between the two surfaces).
The most inner of these two serous layers actually forms the Epicardium and is in direct contact with myocardium

21. Filled with Pericardial Fluid Central tendon of the diaphragm
The Pericardium
Filled with Pericardial Fluid
Pericardio-phrenic
Ligament
Central tendon of the diaphragm

24. Pericardial sinuses Inferior Vena Cava Superior Vena Pulmonary
Arteries
Aorta
trunk
Right
Left
Pericardial sinuses                               

25. Pericardial Sinuses Two In number:
Lies within the pericardial cavity, at the points where the visceral and parietal pericardia are continuous with one another.
The pericardial sinuses are:
transverse pericardial sinus (Open “Connected Lt-Rt”)
Between the reflections of pericardium onto the aorta and pulmonary trunk superiorly and the pulmonary veins inferiorly
oblique pericardial sinus (closed “Not continuous”)
The cul-de-sac enclosed located between the limbs of the U lies behind the left atrium and is known as the oblique sinus,
It is a recess in the pericardial cavity posterior to the base of the heart bounded laterally by the pericardial reflections on the pulmonary veins and inferior vena cava, and posteriorly by the pericardium overlying the anterior aspect of the oesophagus.

27. THE Pericardial reflection Right side view
Oblique
Sinus

28. Innervations
The fibrous pericardium and the parietal layer of the serous pericardium are sensory innervated by the phrenic nerves (C3-C5).
The epicardium receives autonomic innervation from the underlying heart.
Excessive accumulation of fluid in the pericardial cavity and may lead to the compression of the heart.
Restriction of the heart movement may lead to cardiac arrest.

29. Pericardium Relation

30. The Heart Wall