Thoracic cavity ( Mediastinum, Pleura)

Mrs. Benish Islam Coordinator Lecturer Surgical(IPMS) KMU

MEDIASTINUM

Superior:Thoracic outletRoot of neck Inferior:Diaphragm Anterior:Sternum Posterior:Vertebral column It Contains:Thymus,trachea,oesophagus,Thoracicduct,heart,large vessels

Tough thick movable partition.

Inferior mediastinum (3 parts)

Contents of superior mediastinum Thymus Large vein Large arteries Trachea Esophagus Thoracic duct Sympathetic trunk Anterior:Sternum Posterior4 thoracic vertebra

Contents of inferior mediastinumthymusHeart with pericardiumPhrenic nervesEsophagusThoracic ductDescending

aortaSympathetic

trunk

Pleura

Pulmonary ligament

Pleural Space

Parts of pleura

Divisions according to regionsCervical pleura: extends upto neck,

lining undersurface supra pleural membrane, reaches 1-1.5 inch above one third of clavicle.

Costal pleura: linesribs, intercostal cartilage, intercostal space, back of sternum.

Diaphragmatic pleura: covers thoracic surface of pleura.

Mediastinal pleura: covers and forms later boundry of mediastinum.

Nerve Supply:(parietal pleura)Sensitive to pain, pressure,

temperature touch and supplied by:

Costal pleura: intercostal nerves

Mediastinal pleura: phrenic nerves

Diaphragmatic pleura: phrenic nerves and six intercostal nerves

Visceral pleura: Autonomic supply, pulmonary plexus

Pneumothorax

Air+Serous fluid=hydropneumothorax

Air+pus=pyopneumothoraxAir+blood=hemopneumhoraxA collection of pus (no

air)=empyemaSerous fluid= pleural effusion

Needle thoracostomy/Tube thoracostomy

Think pair and shareA patient presented with pain in

chest, there was dullness on percussion and dull breath sounds heard on stethoscope. Pleural effusion is suspected.

Patient is feeling pain in Parietal or Visceral pleura?

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