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Thorax - boundaries

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Plane of Inlet

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45°

Superior Thoracic Aperture

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Suprapleural membrane/ Sibson’s fascia

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Suprapleural membrane: Relations

Inf thoracic aperture-Diaphragm- ant view

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Layers in thoracic wall

Thoracic cavity

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Pleura: Layers1. Visceral

2.Parietal

• Cervical

• Costal

• Diaphragmatic

• Mediastinal

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Parietal pleura

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Pleura: Parts

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PLEURAL REFLECTIONS

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Surface marking

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Surface marking

Pulmonary ligament

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Pleural recesses

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Nerve supply of Pleura Parietal pleura - somatic nerves - Intercostal & phrenic nerve - pain sensitive

Visceral pleura - autonomic nerves - (T2 to T5) & vagus

- pain insensitive

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Mediastinum

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Mediastinum: Boundaries & SUBDIVISIONS

Superior Mediastinum: Boundaries

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• Ant: Manubrium sterni

• Post: T-1 to T-4

• Sides: Mediastinal pleura

• Sup: Plane of thoracic inlet

• Inf: Imaginary line joining

sternal angle and lower

border T-4

Superior Mediastinum - contents

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Superior Mediastinum: Contents

• Muscles:

•Sternohyoid

•Sternothyroid

•Longus colli

• Thymus: in childhood & puberty

• Trachea & Esophagus

• Thoracic Duct

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• Veins • SVC• Lt & Rt brachiocephalic veins• Supreme intercostal veins• Lt Superior Intercostal vein

• Arteries:• Arch of Aorta • Brachiocephalic artery• Lt Common carotid • Lt subclavian artery

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Anterior Mediastinum: Contents

• Thymus (Children)

• Sternopericardial ligaments

• Internal thoracic artery & branches

• Lymphatics & Lymph nodes

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Middle Mediastinum: Contents cont.

Heart enclosed in pericardium

Arteries: Ascending Aorta, Pulmonary trunk with its branches

Veins: SVC, Termination of Azygos, Pulmonary veins

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• Nerves: Phrenic, Deep cardiac plexus

• Bifurcation of Trachea with two principal bronchi

• Tracheobronchial lymph nodes

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Posterior

Mediastinu

m

Contents

Posterior Mediastinum: Contents

• Esophagus• Thoracic duct• Arteries : Descending Aorta with its brs

• Veins: Azygos, Hemiazygos & Accessory hemiazygos

• Nerves: Vagus & Splanchnic nerves• Lymph nodes: Posterior mediastinal

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Applied Anatomy

• Pleuritis/pleurisy

• Pleural effusion / hydrothorax

• Haemothorax

• Empyema

• Referred pain - from diaphragmatic pleura

• Pleural tapping

• Pneumothorax – open, closed, tension33

Tension Pneumothorax• Distended neck veins• Tracheal shift• Decreased breath sounds• Hyper resonance (involved

hemithorax)• Collapsed lung on same

side• Medical emergency• Tt : Needle decompression

2nd ICS in MCL

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Needle decompression 2nd ICS in MCLNeedle decompression 2nd ICS in MCL

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Applied AnatomyApplied Anatomy

• Mediastinitis• Mediastinoscopy

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Mediastinoscopy

Mediastinoscopy

• Intro: Visualization of mediastinum +- biopsy• Indications:

– Staging of lymph nodes of lung cancer– Diagnose sarcoidosis or lymphoma.

• Procedure:– Incision 1 cm above the suprasternal notch– Dissection in pretracheal space upto carina. – Mediastinoscope advanced into the created tunnel – View of the mediastinum

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• Superior Mediastinal syndrome obstruction to SVC

• Engorgement of veins• Dyspnea• Dysphagia• Hoarseness of voice

• Mediastinal shift

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