superior mediastinum

上縦隔

WordNet

1. of or characteristic of high rank or importance; "a superior ruler"
2. one of greater rank or station or quality (同)higher-up, superordinate
3. the head of a religious community
4. (often followed by `to'
5. (sometimes followed by `to'
6. having an orbit farther from the sun than the Earths orbit; "Mars and Jupiter are the closest in of the superior planets"
7. of high or superior quality or performance; "superior wisdom derived from experience"; "superior math students"
8. a town in northwest Wisconsin on Lake Superior across from Duluth
9. the part of the thoracic cavity between the lungs that contains the heart and aorta and esophagus and trachea and thymus

PrepTutorEJDIC

1. (程度・質が)『普通(平均)以上に優れた』,優秀な / (地位・階級などが)『上位の』,上級の,目上の / (数量的に)勝る,優勢な / (用動が)偉ぶった,高慢な / 《補語にのみ用いて》(…に)屈しない,動じない《+to+名》 / 《名詞の前にのみ用いて》(動・植物の器官や部分が)上位の,上についている / (地位・階級などが)『上位の人』,上役,上司,先輩 / 『いっそう優れた人』 / 《しばしば S-》修道院長
2. スペリオル湖(lake~;北米五大湖中で最北最大のもの)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/29 16:57:14」(JST)

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Mediastinum
Mediastinum. The division between superior and inferior is at the sternal angle.
Mediastinum anatomy
Details
Latin	mediastinus
Identifiers
Gray's	p.1090
Dorlands /Elsevier	m_06/12518945
TA	A07.1.02.101
FMA	9826
Anatomical terminology

The mediastinum (from Medieval Latin mediastinus, "midway") is the central compartment of the thoracic cavity surrounded by loose connective tissue, as an undelineated region that contains a group of structures within the thorax. The mediastinum contains the heart and its vessels, the esophagus, trachea, phrenic and cardiac nerves, the thoracic duct, thymus and lymph nodes of the central chest.

Structure

The mediastinum lies within the thorax and is enclosed on the right and left by pleurae. It is surrounded by the chest wall in front, the lungs to the sides and the spine at the back. It extends from the sternum in front to the vertebral column behind, and contains all the organs of the thorax except the lungs. It is continuous with the loose connective tissue of the neck.

The mediastinum can be divided into an upper (or superior) and lower (or inferior) part:

• The superior mediastinum starts at the superior thoracic aperture and ends at the thoracic plane.
• The thoracic plane separates the superior and inferior mediastinum. It is a plane at the level of the sternal angle, and the intervertebral disc of T4-T5.
• The inferior mediastinum from this level to the diaphragm. This lower part is subdivided into three regions, all relative to the pericardium - the anterior mediasteinum being in front of the pericardium, the middle mediastinum contains the pericardium and its contents, and the posterior mediastinum being behind the pericardium.

Anatomists, surgeons, and clinical radiologists compartmentalize the mediastinum differently. For instance, in the radiological scheme of Felson, there are only three compartments (anterior, middle, and posterior), and the heart is part of the anterior mediastinum.

Superior mediastinum

The superior mediastinum is bounded by:

• superiorly by the thoracic inlet, the upper opening of the thorax
• inferiorly by the transverse thoracic plane
• laterally by the pleurae
• anteriorly by the manubrium of the sternum
• posteriorly by the first four thoracic vertebral bodies

Contents

Contents muscles origins of the Sternohyoidei and Sternothyreoidei lower ends of the Longi colli arteries aortic arch brachiocephalic artery thoracic portions of the left common carotid and the left subclavian veins brachiocephalic veins and upper half of the superior vena cava left highest intercostal vein nerves vagus nerve cardiac nerve superficial and deep cardiac plexuses phrenic nerve left recurrent laryngeal nerve trachea esophagus thoracic duct remains of the thymus some lymph glands anterior longitudinal ligament

Thoracic plane

• The thoracic plane separates the superior and inferior mediastinum. It is a plane at the level of the sternal angle, and the intervertebral disc of T4-T5.

A number of structures occur at the level of the thoracic plane, which divides the superior and inferior mediastinum:

Structures at the level of the thoracic plane

The start and end of the aortic arch The division between the superior and inferior mediastinum The upper margin of the superior vena cava The crossing of the thoracic duct The bifurcation of the trachea The bifurcation of the pulmonary trunk The level of the sternal angle The level of Rib 2 where it attaches to the sternum via the 2nd costal cartilage The body of vertebrae T4 The drainage of the azygos vein into the superior vena cava

Inferior mediastinum

Anterior mediastinum

Bounded:

• Laterally by the pleurae
• Posteriorly by the pericardium
• Anteriorly by the sternum, the left transversus thoracis and the fifth, sixth, and seventh left costal cartilages

Contents
Contents A quantity of loose areolar tissue Some lymphatic vessels which ascend from the convex surface of the liver Two or three anterior mediastinal lymph nodes The small mediastinal branches of the internal thoracic artery Thymus (involuted in adults)

Middle mediastinum

Bounded: pericardial sac

Contents
Contents the heart enclosed in the pericardium the ascending aorta the lower half of the superior vena cava with the azygos vein opening into it the bifurcation of the trachea and the two bronchi the pulmonary artery dividing into its two branches the right and left pulmonary veins the phrenic nerves some bronchial lymphatic glands pericardiocophrenic vessels

Posterior mediastinum

It is bounded:

• anteriorly by the pericardium (in front of)
• inferiorly by the thoracic surface of the diaphragm (below).
• superiorly by the transverse thoracic plane
• posteriorally by the bodies of the vertebral column from the lower border of the fifth to the twelfth thoracic vertebra (behind).
• laterally by the mediastinal pleura (on either side)

Contents
artery thoracic part of the descending aorta veins azygos vein the hemiazygos vein and the accessory hemiazygos vein nerves vagus nerve splanchnic nerves sympathetic chain esophagus thoracic duct some lymph glands

Clinical significance

The mediastinum is frequently the site of involvement of various tumors:

• Anterior mediastinum: substernal thyroid goiters, lymphoma, thymoma and teratoma.
• Middle mediastinum: lymphadenopathy, metastatic disease such as from small cell carcinoma from the lung.
• Posterior mediastinum: Neurogenic tumors, either from the nerve sheath (mostly benign) or elsewhence (mostly malignant).

Mediastinitis is inflammation of the tissues in the mediastinum, usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress very quickly, this is a serious condition.

Pneumomediastinum is the presence of air in the mediastinum, which in some cases can lead to pneumothorax, pneumoperitoneum, and pneumopericardium if left untreated. However, that does not always occur and sometimes those conditions are actually the cause, not the result, of pneumomediastinum. These conditions frequently accompany Boerhaave's syndrome, or spontaneous esophageal rupture.

There are many diseases that can present with a widened mediastinum (usually found via a chest x-ray). The most common ones are aortic unfolding, traumatic aortic rupture, thoracic aortic aneurysm, and traumatic thoracic vertebral fracture. A widened mediastinum is a classic but rare hallmark sign of anthrax infection.

See also

• Widened mediastinum
• Mediastinum testis (unrelated structure in the scrotum)
• Mediastinal germ cell tumor
• Mediastinitis
• Anthrax
• Mediastinal tumor

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

Additional images

• A transverse section of the thorax, showing the contents of the middle and the posterior mediastinum. The pleural and pericardial cavities are exaggerated since normally there is no space between parietal and visceral pleura and between pericardium and heart.

External links

• 1691353147 at GPnotebook
• Anatomy figure: 21:01-03 at Human Anatomy Online, SUNY Downstate Medical Center - "Divisions of the mediastinum."
• Anatomy figure: 21:02-03 at Human Anatomy Online, SUNY Downstate Medical Center - "The anatomical divisions of the inferior mediastinum."
• thoraxlesson3 at The Anatomy Lesson by Wesley Norman (Georgetown University) - "Subdivisions of the Thoracic Cavity"

UpToDate Contents

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• 1. 悪性腫瘍関連上大静脈症候群 malignancy related superior vena cava syndrome
• 2. 縦隔における内視鏡的超音波ガイド下穿刺吸引 endoscopic ultrasound guided fine needle aspiration in the mediastinum
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English Journal

• Myeloid Sarcoma: An Unusual Case of Mediastinal Mass and Malignant Pleural Effusion with Review of Literature.

• Sahu KK1, Tyagi R2, Law AD1, Khadwal A1, Prakash G1, Rajwanshi A2, Varma SC1, Malhotra P1.
• Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion.Indian J Hematol Blood Transfus.2015 Dec;31(4):466-71. doi: 10.1007/s12288-015-0536-z. Epub 2015 Apr 1.
• Myeloid sarcoma is an extramedullary tumor seen most commonly in patients with acute myeloid leukemia and less frequently in chronic myeloid leukemia, myelodysplastic syndrome and rarely, in an isolated form without any other underlying malignancy. Malignant pleural effusion in hematological maligna
• PMID 26306072

• Tumoral calcinosis in the neck region involving an unusual site in a hemodialysis patient.

• Pan CW1,2, Chen RF1,3.
• The Laryngoscope.Laryngoscope.2015 Nov 26. doi: 10.1002/lary.25794. [Epub ahead of print]
• Tumoral calcinosis is a rare disorder characterized by calcium salt deposition in the periarticular soft tissue region. It often occurs in the hip, elbow, shoulder, foot, and wrist. Soft tissue calcification associated with tumoral calcinosis is rare in the head and neck. The present case describes
• PMID 26608820

• Fibrosing mediastinitis: a rare complication of histoplasmosis.

• Patel M1, Lu F1, Hannaway M2, Hochman K1.
• BMJ case reports.BMJ Case Rep.2015 Nov 4;2015. pii: bcr2015212774. doi: 10.1136/bcr-2015-212774.
• We report a case of a 29-year-old man who presented with intermittent haemoptysis for about 18 months. Previously, his symptoms had been diagnosed as musculoskeletal pain and later as pneumonia. CT found a venous infarct in the right lung in addition to extensive lymphadenopathy in the mediastinum
• PMID 26538131

Japanese Journal

• FDG-PETで上縦隔リンパ節転移癌様の高集積を呈した傍気管神経鞘腫の1例

• 伊東 真哉,吉村 誉史,大畑 惠資,高橋 耕治,田村 耕一,山下 直己,塙 健
• 気管支学 : 日本気管支研究会雑誌 35(5), 516-520, 2013-09-25
• 背景.神経鞘腫は神経鞘由来の良性腫瘍で,縦隔腫瘍の中では胸腺腫に次いで多い.成人の神経鞘腫は胸腔内では後縦隔に生じることがほとんどであり,上縦隔発生のものは比較的稀である.今回我々は, PETで縦隔リンパ節転移癌様の集積を呈した傍気管神経鞘腫の1例を経験したので報告する.症例.症例は生来健康な47歳男性で,胸部CTで上縦隔に腫瘤を指摘され精査のため入院した. PETでは,腫瘤に一致してFDGの集積 …
• NAID 110009661335

• Pleuroperitoneal Shunt for Refractory Chylothorax Accompanied with a Mediastinal Lymphangioma: A Case Report

• Shiraga Kazuhiro,Terui Keita,Ishihara Kazuaki,Shibuya Kiyoshi,Saito Eriko,Ito Kenichiro,Hiramoto Ryugo
• Annals of Thoracic and Cardiovascular Surgery, 2013
• … Computed tomography showed poor contrast area at superior and anterior mediastinum. … Lymphangioscintigraphy revealed a hot spot at superior mediastinum. …
• NAID 130003387977

• Anterior Mediastinal Lymphoma Arising after Resection of an Invasive Thymoma and Immunosuppressive Therapy for Complicated Myasthenia Gravis

• Hashimoto Kohei,Ohtsuka Takashi,Kohno Mitsutomo,Izumi Yotaro,Hayashi Yuichiro,Nomori Hiroaki
• Annals of Thoracic and Cardiovascular Surgery, 2013
• … Furthermore, she had superior vena cava syndrome that was caused by a rapidly growing tumor. … Because a second primary malignancy, including lymphoma, can occur in patients with thymoma, a biopsy is necessary for tumors located in the anterior mediastinum, particularly in patients with a history of treatment for thymoma, to distinguish between recurrence and a second primary malignancy. …
• NAID 130003377795

Related Links

• superior mediastinum - definition of superior mediastinum by ...

superior mediastinum, the upper part of the mediastinum in the middle of the thorax, containing the trachea, the esophagus, the aortic arch, and the origins of the sternohyoideus and the sternothyroideus. Compare anterior ...

• mediastinum - definition of mediastinum by Medical dictionary

... all the thoracic viscera and structures except the lungs. It is divided arbitrarily into two major divisions: the superior mediastinum [TA] (mediastinum superus [TA]), which lies directly superior to a horizontal plane intersecting ...

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★リンクテーブル★

リンク元	「上縦隔」
関連記事	「superior」「superio」

「上縦隔」

　　[★]

英

superior mediastinum (M)

• 胸郭上口から下
• 胸骨角と第4胸椎下縁を通る面まで　→ 横胸面 transverse thoracic plane
• 上大静脈、腕頭静脈、大動脈弓、胸管、気管、食道、胸腺、迷走神経、左反回神経、横隔神経

「superior」

　　[★]

• adj.

• 優位な, 優れた, 上の, 上方の, 上位の

関

dominance、dominant、dominantly、epi、epistasis、epistatic、excellent、good、predominately、senior、superio、superiorly、supra

　 　 　 　 　 　 　 　

「superio」

　　[★]

• comb form.

• 上位、上

関

epi、epistasis、epistatic、senior、superior、supra