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ConceptPleuraShapeoflungDissectionofsuperiormediastinum Dept ofHumanAnatomy GuangxiMedicalUniversityLaoMing0310 0804 Thorax Thoraciccavity 1 Thoraciccage Formedbysternum ribs thoracicvertebrae Thoraciccavity FormedbythoraciccageContents lungs pleuralcavitymediastinum musclesofthoraxPectoralismajorPectoralisminorSerratusanteriorIntercoastalesexterniIntercoastalesinternidiaphragm musclesofabdomenRectusabdominisObliquusexternusabdominisObliquusinternusabdoministransversusabdominis Pleura Movedoftheanteriorthoracicwall Anteriormarginformed TriangleofthymusTriangleofpericardium Havenocoveringofpleura Thelineofreflectionofpleurae Projectionofinferiormarginoflungsandpleura Pleuralcavity betweenparietalpleuraandvisceralpleura containafilmoffluid negativepressure notcommunicateswithleftandrightone Costodiaphragmaticrecess costalanddiaphragmaticpleurareflection whenstandingandseating it sthelowestplaceofthepleuralcavity Pleuralrecess thecavityoftheparietalpleuralreflectiondoesnotoccupiedbyexpandedlungindeepbreathing Costomediastinalrecess costalandmediastinalpleurareflection Obviousonlyonleftside CostalsurfaceDiaphragmaticsurfaceAnt border cardiacnotchofleftlung Lingualofleftlung Post borderInf border Shapeoflungs halfconical rightlungshorterandwider Apexoflung extendtoabout2 3cmabovemedialone thirdoftheclavicle Mediastinalsurface hilumoflung rootoflung Baseoflung Concept ThestructuresEnteringandleavingthehilumoflungssurroundedbypleura Therootofthelung Therelationshipofpulmonaryroot above Infront behind LeftphrenicNPericardiacophrenicA V Aorticarch ThoracicaortaLeftvagusN RightphrenicNPericardiacophrenicA V ArchofazygosV AzygosVRightvagusN Leftright Procedure1 cutthrough1stto12thribsjustpost tomidaxillaryline2 elevatetheupperendofant thoracicwallpushawaytheparietalpleurafromthethoracicwallandpericardium cutthroughtheinternalthoracicA3 cutthroughthethreeflatmusclesofabdomenalongmidaxillarylineandattachmentofdiaphragm4 pushawaytheparietalperitoneumfromtheabdominalwalluntiltothelevelofumbillium5 Cutthroughthepulmonaryrootfrombeforebackwardclosetothehilumofthelungs takeoutoflungs Reflectanteriorthoracicandabdominalwall Observation1 Internalsurfaceofanteriorthoracicwall internalthoracicA transversethoracicM2 Thepartofpleura anteriormarginofpleura triangleofthymus pericardiumandtheircontents3 Costodiaphragmaticrecess Costomediastinalrecess4 Position shapeoflungs apex base threesurfaces lobe arrangementofthestructuresinhilumoflung andrelationshipofrootoflungs 5 Intercostalnerveandbloodvessels Alltheorgansandstructuresbetweenrightandleftpleuralsacs Mediastinum Concept Part four area Sup mediastinum Ant mediastinum mid mediastinum Inf mediastinum Themaincontentsofsuperiormediastinum 1 Thymusorremnants2 Superiorvenacava L RBrachiocephalicV PhrenicN VagusN3 Aorticarchanditsbranches Brachiocephalictrunk L commoncarotid L subclavianA 4 Trachea Esophagus Thoracicduct Sympathetictrunk fourstrata frombeforebackward BoundariesInfront LphrenicNBack L vagusNLower LpulmonaryAContentsArterialligamentLrecurrentlaryngealN Ductusarterioustriangle Locationinleftsideofsuperiormediastinum Dissectionofsuperiormediastinum Procedure1 stripthemediastinalpleurafrombothsides2 cleanthymusorremnants reflectitupward3 cleaninturnsuperiorvenacava L andR brachiocephelicVfromlowerupward4 cleanphrenicN vagusNfromneckdownward5 onleftside cleantheductusarterioustrianglelookforL phrenicN LvagusN andLpulmonaryA arterialligament L recurrentlaryngealN6 onrightside lookforazygosarch azygosV7 c
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