Download Subdivisions of mediastinum

Subdivisions of mediastinum
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Superior mediastinum
上纵隔
• Inferior mediastinum
下纵隔
– Anterior mediastinum
前纵隔
– Middle mediastinum
中纵隔
– Posterior mediastinum
后纵隔
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Contents of the heart
Cardiac development embryology
Pericardium
Chambers of the heart
Structure of the heart
Conduction system of heart
Coronary artery and Venous drainage
Surface Anatomy
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Development of the heart
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Cardiac development embryology
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Schematic illustration of the heart showing
orientation, surfaces, and margins.
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Chest Xray showing right heart,
anterior view
1. Right atrium
2. Right ventricle
3. Apex (left ventricle)
4. Superior vena cava
5. Inferior vena cava
6. Tricuspid valve
7. Pulmonary valve
8. Pulmonary trunk
9. Right pulmonary a.
10.Left pulmonary a.
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Pericardium
Fibrous pericardium 纤维心包
• Attached to central tendon of
diaphragm inferiorly
• Blends with outer coat of great
vessels superiorly
Serous pericardium 浆膜心包
• Visceral pericardium
(epicardium)
• Parietal pericardium
Pericardial cavity 心包腔
• Potential space between visceral
and parietal pericardium
• Contains film of pericardium fluid
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Chest X-ray showing pericardium,
posteroanterior view
1. Heart
2. Fibrous pericardium
3. Parietal layer of
serous pericardium
4. Visceral layer of
serous pericardium
5. Pericardial space
6. Pleural cavity and
lung
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Pericardium sinus
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Transverse sinus of pericardium 心包横窦－posterior
to ascending aorta and pulmonary trunk, anterior to
superior vena cava and left atrium.
Oblique sinus of pericardium 心包斜窦－cul-de-sac ,
posterior to heart, bounded by pulmonary veins on
either side
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Fetal circulation
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Chambers of the heart
Right atrium (RA）
Three inlets
• Orifice of superior
vena cava 上腔静脉口
• Orifice of inferior vena
cava 下腔静脉口
• Orifice of coronar
sinus 冠状窦口
One outlet
right atrioventricular
orifice 右房室口
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Right atrium (RA）
Sinus of venae cavae
腔静脉窦
Interatrial
septum
房间隔
Fossa ovalis
卵圆窝
Atrium proper
固有心房
Right auricle
右心耳
Crista terminalis界嵴
Sulcus terminalis 界沟
Pectinate m.
梳状肌
Valve of IVC
Valve of coronary
sinus
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Right ventricle (RV)
• One inlet－right
artrioventricular orifice
右房室口
• One outlet－orifice of
pulmonary trunk
肺动脉口
• Two parts－divided by
the supraventricular
crest 室上嵴
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Right ventricle (RV)
Conus arteriosus
Outflow tract
Supraventricular
crest
Inflow tract
Septomarginal
trabecula
(moderator band)
Ant.papillary m.
Trabeculae carneae
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Left atrium (LA)
• Left auricle左心耳
Four inlets
－four orifices of
pulmonary veins
肺静脉口
One outlet
－left atrioventricular
orifice 左房室口
•Interventricular septum
室间隔
membranous part
muscular part
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Left ventricle (LV)
• One inlet－left
atrioventricular orifice
左房室口
• One outlet－aortic orifice
主动脉口
• Two parts
– Inflow tract－rough walls
– Outflow tract – aortic
vestibule 主动脉前庭,
smooth area leading to
aortic orifice
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Structure of the heart
Fibrous rings that surround the
atrioventricular, pulmonary, and
aortic orifices
Left fibrous trigone
Right fibrous trigone
(Central fibrous body)
Fibrous skeleton
纤维骨骼
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Structure of the heart
• Endocardium心内膜－
inner coat of the heart
wall, and continuous with
the valve flaps
• Myocardium 心肌
– Arranged spirally
– Attached to fibrous
rings surrouding the
four orifices of heart
• Epicardium 心外膜－
serous membrane
(visceral pericardium)
Walls of heart
心壁
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Myocardium 心肌
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Conduction system of heart
Sinuatrial node 窦房结
(SA -N)
Atrioventricular node
房室结 (AV -N)
Right and left bundle
branches 左、右束支
Purkinje fibers 普肯野氏
纤维 －continuous with
myocardium
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Coronary artery
Left coronary artery
Right coronary artery
Anterior interventricular
branch 前室间支（前降支）
Circumflex branch 旋支
Right marginal branch
右缘支
Posteror interventricular
branch 后室间支
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Coronary arteries and veins
Left marginal branch
Great cardiac v.
Coronary
sinus
Small cardiac v.
Middle cardiac v.
Right marginal branch
Diagonal branch l
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Surface Anatomy: Heart valve
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Left side of mediastnum
Left subclavian a.
Thoracic duct
Left vagus n.
Left recurrent n.
Phrenic n. &
pericardiacophrenic a.
Aortic arch
Thoracic aorta
Sympathetic trunk
Root of lung
Pericardium
Esophagus
Greater splanchnic n
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Right side of mediastnum
Trachea
Left vagus n.
Arch of azygos v.
Azygos v.
Sympathetic trunk
Esophagus
Superior vena cava
Phrenic n. &
pericardiacophrenic a.
Root of lung
Pericardium
Inferior vena cava
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Superior mediastinum
Contents
• Superficial layer
– Thymus
– Three veins
Left
brachiocephelic v.
Right
brachiocephelic v.
Superior vena cava
(SVC)
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• Middle layer
Aortic arch
and its three
branches
Phrenic n.
Vagus n.
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• Posterior layer
Trachea
Esophagus
Thoracic duct
Left recurrent
laryngeal n.
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Relations of aortic arch
• Anteriorly and to the left
－pleura, lung，phrenic n.,
pericardiacophrenic vessels
and vagus n.
• Posteriorly and to the right
－trachea, esophagus, left
recurrent n., thoracic duct,
deep cardiac plexus
• Superiorly－its three
branches, left brachiocephalic
v. and thymus
• Inferiorly－pulmonary a.,
arterial ligament, left recurrent
n., left principal bronchus and
superficial cardiac plexus
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Cross-section through the superior
mediastinum at the level of vertebra TIII.
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Contents of Inferior mediastinum
Anterior mediastinum
fat, remnants of thymus gland, anterior mediastinal
lymph nodes
Middle mediastinum
heart and pericardium, beginning or termination of
great vessels, phrenic nerves, pericardiacophrenic
vessels , lymph nodes
Posterior mediastinum
esophagus, vagus n., thoracic aorta, azygos system
of veins, thoracic duct, thoracic sympathetic trunk,
posterior mediastinal lymph nodes
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1.Esophagus
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2.Relations of thoracic aorta
• Anteriorly－left root of lung,
pericardium and esophagus
• Posterior－ hemiazygos v.,
accessory hemiazygos v.,
• Right－azygos v. and
thoracic duct
• Left－mediastinal pleura
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Arterial ligament 动脉韧带－ remnant of ductus
arteriosus, connects bifurcation of pulmonary
trunk to inferior border of aortic arch
Triangule of ductus arteriosus 动脉导管三角
• Bounded by phrenic n., left vagus n. and left
pulmonary a.
• Contents－ arterial ligament , left recurrent n.
and superficial cardiac plexuses
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3.Azygos vein 奇静脉
hemiazygos v.半奇静
脉 and accessory hemiazygos v. 副半奇静脉
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4.Thoracic duct 胸导管
• 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
Begins in
front of L1
as a dilated
sac, the
cisterna
chyli 乳糜池
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5.Thoracic sympathetic
trunk 胸交感干
• 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.
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Cardiac plexuses
Sympathetic n.
Parasympathetic n.
sympathetic
parasympathetic
sensory fibers.
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