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24. TOPOGRAPHIC ANATOMY AND OPERATIVE SURGERY OF MEDIASTINUM

Topics of the lesson. Mediastinum. Definition, division into parts. Thymus. Topography of the heart and pericardium. Trachea, bronchi, phrenic nerve. Esophagus. Vagus nerve. Sympathetic trunk. Arterial plexus. Celiac nerves. Aorta, azygos and hemi-azygos veins. Thoracic lymphatic duct. Parietal and visceral lymph nodes. Reflexogenic zones of the thoracic cavity. Surgical accesses to the lungs, esophagus, aorta and heart. Seam of heart. Principles of pulmonary operations: pulmonectomy, lobectomy, segmen-tectomy. Surgical treatment of purulent lung diseases. Surgery for valvular pneumotho-rax. Aortocoronary bypass.

24.1. Using Fig. 24.1, sign the names of organs and parts of mediastinum.

Fig. 24.1. Topography of the mediastinum

PARTS OF MEDIASTINUM

ANATOMICAL STRUCTURES

Superior mediastinum

Vessels

Nerves

Organs

Other structures

PARTS OF MEDIASTINUM

ANATOMICAL STRUCTURES

Anterior mediastinum

Vessels

Nerves

Organs

Other structures

Middle mediastinum

Vessels

Nerves

Organs

Other structures

Posterior mediastinum

Vessels

Nerves

Organs

Other structures

24.2. What arteries are supplying the heart?_

_

Where do they start from?_

Sign the names of the arteries of heart in English and Latin presented in Fig. 24.2.

Fig. 24.2. Blood supply to the heart

24.3. Sign the names of the veins of heart in English and Latin from Fig. 24.3.

Fig. Veins of heart

24.4. Name the sinuses of pericardium and the confluence of vessels of heart presented in Fig. 24.4 in English and Latin.

Fig. 24.4. Topography of the pericardium

24.5. Explain the situation in this clinical case.

A surgical unit received a wounded man with symptoms of cardiac tamponade. It is considered to puncture the pericardial cavity through the anterior abdominal wall. Give topographic and anatomical grounding for the operation.

Fig. 24.5. Puncture the pericardial cavity

At what point is the puncture performed?_

_

_

Why this point was chosen?_

_

_

_

Through what layers does the needle pass (8)?_

_

_

_

_

_

What part of the pericardial cavity does it enter?_

_

24.6. Describe syntopy of the thoracic aorta and its branches in English and Latin using Fig. 24.6.

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