4.5: Anterior Mediastinum

 

Potential space between sternum & pericardium.

Overlapped by anterior edges of both lungs.

Continuous with pretracheal space of neck through superior mediastinum (\ infections in pretracheal space ¨ anterior mediastinitis). 

Contents: i) thymus, ii) sternopericardial ligaments, iii) lymph nodes, iv) branches of internal thoracics.

Thymus

Bilobed organ.  Most prominent in children, running from lower pole of thyroid ¨ 4th CC.  Lies behind pretracheal fascia, long straps & manubrium/sternum.

-           behind is pericardium, arch of aorta, L brachiocephalic, trachea

 Different colour to fat: pinker or browner, lobules larger/smoother/denser.  Pretracheal fascia is key to exposure of thymus; gland is dissected from its posterior surface. 

Blood supply

From inferior thyroid and internal thoracic arteries & corresponding veins. 

-           a large short thymic vein may enter the L brachiocephalic

Lymphatics

No afferent channels.  Drains into parasternal, tracheobronchial & brachiocephalic nodes. 

Development

From epithelium of 3rd pouch; same one as inferior parathyroids.  Epithelial cells ¨ (1) thymic (HassallŐs) corpuscles and (2) reticular cells ?concerned with T cell differentiation.

-           as everywhere, surrounding mesoderm supplies connective tissue elements

-           colonising lymphocytes come from bone marrow.

Access: via median sternotomy.