1

Superior and Posterior

Mediastinum• Surface anatomy and heart sounds

-Dry lecture

-Gray’s 169, 203-205

• Mediastinum

-Gray’s pp. 181-199

-Gray’s dissector pp. 102-112

• Review

-Gray’s dissector pp. 44-45

-Gray’s dissector pp. 113-114

Review of the Subdivisions of the Mediastinum

Syllabus p. 50

2

Superior Mediastinum:Thymus

Arch of the Aorta

Syllabus p. 51

3

Arch of the Aorta

Aortic Angiogram

4

Brachiocephalic Veins and Superior Vena Cava

*key feature – left brachiocephalic vein is twice as long as the right brachiocephalic vein

Brachiocephalic Veins and Superior Vena Cava

Syllabus p. 106

5

A central venous line is required to administer large amounts of

fluid to a patient. The line is introduced in the left internal jugular

vein and the tip is subsequently passed to the right atrium. Identify

the correct course of the venous line.

Lef

t inte

rnal

jugula

r v.,.

..

Lef

t inte

rnal

jugula

r v.,.

..

Lef

t inte

rnal

jugula

r v.,.

..

Lef

t inte

rnal

jugula

r v.,.

..

Lef

t inte

rnal

jugula

r v...

.

20% 20%

40%

20%

0%

A. Left internal jugular v., left subclavian v., leftbrachiocephalic v., superior vena cava, rightatrium

B. Left internal jugular v., left subclavian v.,superior vena cava, right atrium

C. Left internal jugular v., left brachiocephalic v.,superior vena cava, right atrium.

D. Left internal jugular v., left axillary v., leftsubclavian v., left brachiocephalic v., superiorvena cava, right atrium

E. Left internal jugular v., superior vena cava, rightatrium

A surgeon needs to close a patent ductus arteriosus.

The surgeon needs to avoid the ________ nerves that

course around the patent ductus arteriosis.

right v

agus

and re

cu...

right p

hrenic

and re

c...

C. l

eft v

agus

and p

hr...

D. l

eft v

agus

and re

cu...

E. l

eft p

hrenic

and re

c...

20% 20%

40%

0%

20%A. right vagus and recurrent laryngeal

B. right phrenic and recurrentlaryngeal

C. left vagus and phrenic

D. left vagus and recurrent laryngeal

E. left phrenic and recurrent laryngeal

6

Nerves of the Superior Mediastinum

Syllabus p. 52

Trachea and Esophagus

Syllabus p. 108

7

Nerves of the Posterior Mediastinum

Syllabus p. 53

Vasculature of the Posterior Mediastinum

Syllabus p. 54

8

Thoracic Duct and Azygos System of Veins

Posterior Mediastinum (Thoracic Aorta)

Syllabus p. 55

9

During surgery in the left abdomen the lymphatics that

drain to the thoracic duct are accidentally damaged. The

thoracic duct drains into the ____________

junct

ion o

f the

right i

n...

left

brach

ioce

phalic

v.

C. r

ight b

rach

ioce

pha...

D. j

unctio

n of t

he le

ft ...

E. j

unctio

n of t

he ao

rt..

20% 20% 20%20%20%

A. junction of the right internaljugular and subclavian vv.

B. left brachiocephalic v.

C. right brachiocephalic v.

D. junction of the left internaljugular vein and subclavian vv.

E. junction of the aortic arch andleft common carotid a.

Putting It All Together

10

Putting It All Together

To The Students

You will remember a little of what you hear,

some of what you read,

considerably more of what you see,

but almost all of what you understand

11

Screen 2

Review of the Subdivisions of the Mediastinum

12

Arch of the Aorta

Aortic Angiogram

13

Brachiocephalic Veins and Superior Vena Cava

Left Vagus Nerve

14

Right Vagus Nerve

Trachea and Esophagus

15

Thoracic Duct and Azygos System of Veins

Posterior Mediastinum (Thoracic Aorta)

16

Putting It All Together

Putting It All Together