Henry Gray (1821–1865). Anatomy of the Human Body. 1918.
The mediastinum lies between the right and left pleurae in and near the median sagittal plane of the chest. It extends from the sternum in front to the vertebral column behind, and contains all the thoracic viscera excepting the lungs.
It may be divided for purposes of description into two parts: an upper portion, above the upper level of the pericardium, which is named the superior mediastinum and a lower portion, below the upper level of the pericardium. This lower portion is again subdivided into three parts, viz., that in front of the pericardium, the anterior mediastinum that containing the pericardium and its contents, the middle mediastinum and that behind the pericardium, the posterior mediastinum
The Superior Mediastinum (Fig. 967) is that portion of the interpleural space which lies between the manubrium sterni in front, and the upper thoracic vertebrae behind. It is bounded below by a slightly oblique plane passing backward from the junction of the manubrium and body of the sternum to the lower part of the body of the fourth thoracic vertebra, and laterally by the pleurae.
It contains the origins of the Sternohyoidei and Sternothyreoidei and the lower ends of the Longi colli; the aortic arch; the innominate artery and the thoracic portions of the left common carotid and the left subclavian arteries; the innominate veins and the upper half of the superior vena cava; the left highest intercostal vein; the vagus, cardiac, phrenic, and left recurrent nerves; the trachea, esophagus, and thoracic duct; the remains of the thymus, and some lymph glands.
FIG. 967– Transverse section through the upper margin of the second thoracic vertebra. (Braune.) (Picture From the Classic Gray's Anatomy)
FIG. 968– A transverse section of the thorax, showing the contents of the middle and the posterior mediastinum. The pleural and pericardial cavities are exaggerated since normally there is no space between parietal and visceral pleura and between pericardium and heart. (Picture From the Classic Gray's Anatomy)
The Anterior Mediastinum (Fig. 968) exists only on the left side where the left pleura diverges from the mid-sternal line. It is bounded in front by the sternum, laterally by the pleurae, and behind by the pericardium. It is narrow, above, but widens out a little below. Its anterior wall is formed by the left Transversus thoracis and the fifth, sixth, and seventh left costal cartilages.
It contains a quantity of loose areolar tissue, some lymphatic vessels which ascend from the convex surface of the liver, two or three anterior mediastinal lymph glands, and the small mediastinal branches of the internal mammary artery.
FIG. 969– The middle and posterior mediastina. Left side. (Picture From the Classic Gray's Anatomy)
The Middle Mediastinum (Fig. 968) is the broadest part of the interpleural space. It contains the heart enclosed in the pericardium, the ascending aorta, the lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery dividing into its two branches, the right and left pulmonary veins, the phrenic nerves, and some bronchial lymph glands.
The Posterior Mediastinum (Figs. 968, 969) is an irregular triangular space running parallel with the vertebral column; it is bounded in front by the pericardium above, and by the posterior surface of the diaphragm below, behind by the vertebral column from the lower border of the fourth to the twelfth thoracic vertebra, and on either side by the mediastinal pleura. It contains the thoracic part of the descending aorta, the azygos and the two hemiazygos veins, the vagus and splanchnic nerves, the esophagus, the thoracic duct, and some lymph glands.
The mediastinum is frequently the site of involvement of various tumors:
- Anterior mediastinum: substernal thyroid goiters, lymphoma, thymoma, and teratoma.
- Middle mediastinum: lymphadenopathy, metastatic disease such as from small cell carcinoma from the lung.
- Posterior mediastinum: Neurogenic tumors, either from the nerve sheath (mostly benign) or elsewhere (mostly malignant).
Mediastinitis is inflammation of the tissues in the mediastinum, usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress very quickly, this is a serious condition.
Pneumomediastinum is the presence of air in the mediastinum, which in some cases can lead to pneumothorax, pneumoperitoneum, and pneumopericardium if left untreated. However, that does not always occur and sometimes those conditions are actually the cause, not the result, of pneumomediastinum. These conditions frequently accompany Boerhaave syndrome, or spontaneous esophageal rupture.
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- Anatomy figure: 21:01-03 at Human Anatomy Online, SUNY Downstate Medical Center – "Divisions of the mediastinum."
- Anatomy figure: 21:02-03 at Human Anatomy Online, SUNY Downstate Medical Center – "The anatomical divisions of the inferior mediastinum."
- thoraxlesson3 at The Anatomy Lesson by Wesley Norman (Georgetown University) – "Subdivisions of the Thoracic Cavity"
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