2. Thoracic cavity ( Mediastinum, Pleura) Mrs. Benish Islam Coordinator Lecturer Surgical (IPMS) KMU

4. MEDIASTINUM Superior: Thoracic outlet Root of neck Inferior: Diaphragm Anterior: Sternum Posterior: Vertebral column It Contains: Thymus,trachea,oesophagus, Thoracicduct,heart,large vessels Tough thick movable partition.

6. Inferior mediastinum (3 parts)

7. Contents of superior mediastinum Thymus Large vein Large arteries Trachea Esophagus Thoracic duct Sympathetic trunk Anterior: Sternum Posterior 4 thoracic vertebra

8. Contents of inferior mediastinum thymus Heart with pericardium Phrenic nerves Esophagus Thoracic duct Descending aorta Sympathetic trunk

9. Pleura

10. Pulmonary ligament

11. Pleural Space

12. Parts of pleura

13. Divisions according to regions Cervical pleura: extends upto neck, lining undersurface supra pleural membrane, reaches 1-1.5 inch above one third of clavicle. Costal pleura: linesribs, intercostal cartilage, intercostal space, back of sternum. Diaphragmatic pleura: covers thoracic surface of pleura. Mediastinal pleura: covers and forms later boundry of mediastinum.

15. Nerve Supply: (parietal pleura) Sensitive to pain, pressure, temperature touch and supplied by: Costal pleura: intercostal nerves Mediastinal pleura: phrenic nerves Diaphragmatic pleura: phrenic nerves and six intercostal nerves Visceral pleura: Autonomic supply, pulmonary plexus

16. Pneumothorax

17. Air+Serous fluid=hydropneumothorax Air+pus=pyopneumothorax Air+blood=hemopneumhorax A collection of pus (no air)=empyema Serous fluid= pleural effusion

18. Needle thoracostomy/ Tube thoracostomy

19. Think pair and share A patient presented with pain in chest, there was dullness on percussion and dull breath sounds heard on stethoscope. Pleural effusion is suspected. Patient is feeling pain in Parietal or Visceral pleura?

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