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General Surgery
Mediastinum
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
11 sections · 165 slides
Overview
- Definition and extent of the mediastinum
- Principal contents of the mediastinum
Embryogenesis
- Embryonic origin of the mediastinum
- Mesenteries of the oesophagus
- Dorsal and ventral mesoesophagus
- Complete adult mesoesophagus
- Surgical relevance of the shared embryologic origin
Boundaries and compartments
- Rationale for subdividing the mediastinum
- Traditional superior and inferior division
- Subdivisions of the mediastinum
- Anatomic divisions labelled by compartment
- The three-part scheme of Burkell et al.
- Three-compartment division of Burkell
- Preferred subdivision used in this chapter
- Six-compartment scheme
- Limitations of rigid compartment lists
Superior mediastinum
- Thymus in the anterior superior mediastinum
- Retrosternal goitre and ectopic parathyroid glands
- The three Ts of the anterior superior mediastinum
- Internal thoracic vessels and the thyroid ima artery
- Brachiocephalic veins and the superior vena cava
- Surgical hazard of the left brachiocephalic vein
- Azygos arch, aortic arch and its branches
- Left vagus nerve at the aortic arch
- Structures at the thoracic inlet
- Course of the phrenic nerves
- Right phrenic nerve on the great venous channel
- Course of the vagus nerves
- Right vagus nerve applied to the trachea and oesophagus
- Right and left mediastinal views compared
- Mediastinum viewed from the right side
- Mediastinum viewed from the left side
- Thoracic course of the trachea
- Retrotracheal triangle
- Cervical and thoracic course of the oesophagus
- Sites of oesophageal luminal constriction
- Achalasia and minimally invasive approaches
- Sympathetic trunks in the superior mediastinum
- Anatomic entities at the level of the fourth thoracic vertebra
Inferior mediastinum
- Boundaries of the inferior mediastinum
- Anterior inferior compartment
- Middle inferior compartment
- Posterior inferior compartment
- Commonest tumour by compartment
Posterior mediastinal structures
- Course of the descending thoracic aorta
- Thoracic aorta with trachea and oesophagus from the left
- Posterior intercostal arteries
- Intercostal arteries
- Great radicular artery of Adamkiewicz
- Bronchial and oesophageal arterial supply
- Aberrant right subclavian artery and the non-recurrent nerve
- Four segments of the thoracic oesophagus
- Thoracic and abdominal portions of the oesophagus
- Clinical consequences of oesophageal relations
- Vagal contributions to the oesophageal plexus
- Cisterna chyli
- Cisterna chyli and the origin of the thoracic duct
- Thoracic course of the duct
- Oblique thoracic course of the definitive thoracic duct
- Thoracic duct crossing the vertebral column
- Termination of the thoracic duct
- Variations in the venous entry of the thoracic duct
- Thoracic sympathetic chain
- Stellate ganglion and its connections
- Rami communicantes
- Thoracic visceral and splanchnic nerves
- Thoracic sympathectomy
- Compensatory sweating after sympathectomy
- Azygos vein
- Hemiazygos and accessory hemiazygos veins
- Left superior intercostal vein and the aortic nipple
Lymphatics of the mediastinum
- Caplan's topographic study of mediastinal nodes
- Mediastinal quadrants of Caplan
- Anterior, middle and posterior mediastinal planes
- Two principal groups of thoracic lymph nodes
- Parasternal nodes
- Scalene node
- Intercostal nodes
- Anterior mediastinal lymph nodes
- Right anterior mediastinal nodal chains
- Left anterior mediastinal nodal chains
- Posterior mediastinal lymph nodes
- Castleman's disease in the posterior mediastinum
- Tracheobronchial lymph nodes
- Middle mediastinal or visceral nodal chains
- Tracheo-oesophageal and lateral oesophageal chains
- Lymph nodes of the trachea, bronchi and lungs
- Drainage pathways and the bronchomediastinal trunks
- Regional nodal classification for staging
- Regional lymph node map for staging
Mediastinal masses
- General principles for mediastinal tumours
- Reading the mediastinal tumour tables
- Classification of Primary Mediastinal Tumors and Cysts
- Classification of Primary Mediastinal Tumors and Cysts (continued)
- Classification of Primary Mediastinal Tumors and Cysts (continued)
- Primary Mediastinal Tumors and Cysts in 2431 Patients
- Primary Mediastinal Tumors and Cysts in 2431 Patients (continued)
- Anatomic Location of Primary Tumors and Cysts of the Mediastinum
- Anatomic Location of Primary Tumors and Cysts of the Mediastinum (continued)
- Anatomic Location of Primary Tumors and Cysts of the Mediastinum (continued)
- Primary Mediastinal Tumors and Cysts in Children
- Primary Mediastinal Tumors and Cysts in Children (continued)
- Cardiovascular Abnormalities That May Appear as a Mediastinal Mass
- Cardiovascular Abnormalities That May Appear as a Mediastinal Mass (continued)
- Algorithm for anterior mediastinal masses
- Mediastinal lipomatosis and compartment schemes
Surgery and its complications
- Surgical approaches to the mediastinum
- Extended approaches and reported series
- Radiographic signs of pneumomediastinum
- Visceral compartment of the neck
- Sagittal section of the neck showing the danger space
- Retrovisceral space and the spread of infection
- Pretracheal space
- Complications of mediastinoscopy
- Avoiding injury at mediastinoscopy
- Mediastinal false aneurysm
Thymus
- Historical study of thymic development
- Development from the third branchial pouch
- Pharynx with the third and fourth branchial pouches
- Long section through the third pouch derivatives
- Elongation of the thymic portion of the third pouch
- Descent and fusion of the thymic primordia
- Descent of the thymus at the end of the second month
- Maturation of the thymus in fetal life
- Cortex, medulla and reticulum cells
- Hassall's corpuscles
- Chronology of the Developing Thymus
- Failure of thymic descent
- Accessory and cervical thymus
- Thymic cysts
- Thymic Agenesis, Aplasia, and Hypoplasia: thymic findings
- Thymic Agenesis, Aplasia, and Hypoplasia: lymphocytes and anomalies
- Thymic Agenesis, Aplasia, and Hypoplasia: aetiology
- Thymic Agenesis, Aplasia, and Hypoplasia: treatment and prognosis
- DiGeorge syndrome and severe combined immunodeficiency
- Other thymic abnormalities
- Surgical anatomy of the thymus
- Age changes in the weight of the normal human thymus
- Arterial supply of the thymus
- Venous drainage and the great vein of Keynes
- Surgical anatomy of the thymus
- Vascular system of the thymus
- Lymphatics and innervation of the thymus
- Histology of the thymus
- Endocrine function of the thymus
- Role of thymic epithelial cells
- Differentiation of haematopoietic stem cells
- Anatomic complications of thymic surgery
Summary
- Compartments and their commonest masses
- Structures that cross the whole mediastinum
- Operative warnings from this chapter
- References
- References (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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