Anterior middle. Front and rear middle cordon

Seredostinnya є region, roztashovanu mіzh pleural bears. Between the lateral mediastinal pleura, it stretches from the upper thoracic aperture to the diaphragms and from the sternum to the ridge. The middle of a potentially crumbling one, in the norm, settles down in the middle of the position as a result of a vise in both pleural empty spaces. In small cases, open the mediastinal pleura with pleural bears. In infants and children early vik The middle is superficially ruchomy, in a given age there are more rigorous, so one-sided squeeze in the pleural emptying put on a new apparently mensha.

Fig. 34. Pidrozdili middle.

Anatomy extend the middle by 4 parts (Fig. 34). The lower border of the upper middle є area, drawn through the handle of the sternum and IV chest ridge. It is sufficient for the border to pass below the aortic arch immediately above the bifurcation of the trachea. The anatomical cordon of the leading figures is presented in Table 18. The breakdown of the bigger ones in the middle can change the anatomical cordon, so that I will get rid of the dilyanka, get a borrowing of its own zone, in the broadest possible way. The snakes in the small, rearranged upper middle are especially strong and pass over to the cordon. However, in the normal course of coverage, it expands more by one side, for example, the thymus, which is pulled outwards through the upper middle to the anterior, the aorta and stravochid, which expands to the upper back, so to the middle. Anatomical subdivision of the middle is not very important, the level of localization in the middle is given a valuable information when diagnosed (Table 19 and Fig. 35). Protect the diagnosis must be established rather quickly, and it is still possible to develop good and bad decisions before removing accurate histological data. In 1/5 of the pockets, or the middle brush, there can be a malignant degeneration.

Fig. 35. Localization of poohlin and cyst middle on a normal X-ray.

The middle is a part of the chest empty, which is located between the pleural bears (we are right), in front of the chest is the sternum, at the back is the ridge, and the very chest is visible, the lower middle of the middle is as a group of organs grows between the middle parts of the parietal pleurisy of the lungs). cleverly see two in the middle : Upper middle and lower middle. Pod_lisnyuє to go along the horizontal area, to pass the area through the cordon between the handle and the middle of the sternum and the middle between the fourth and the five chest ridges (meaning less memory, the upper middle of the lungs, and the lower roots are in the root)

• front middle It is located between the anterior part of the thorax, and also the anterior part of the pericardium. The anterior middle includes the internal thoracic blood vessels (arteries and veins), as well as the lymph nodes of the anterior middle, near-chest and pre-cardiac.
• middle middle It is designated by the boundaries of the front surface and back surface of the heart shirt. The middle middle includes in itself the heart and th pericardium, as well as the intrapericardial viddili of great blood-bearing vessels, leguminous arteries and veni, head bronchi, diaphragm nerves, lymph nodes.
• rear middle to be found mіzh rear pericardium і vlasne ridge. (Kudi is simpler to say, the front middle is in front of the heart, the rear is behind it, and the empty pericardium, decelerated heart and still deceased, is the middle middle). The posterior middle includes a part of the lower aorta, the veni (semi-unpaired and unpaired), the lower elements of the duct and the sympathetic stings, the thoracic lymph duct, the bloating nerves, the posterior mid-forehead lymphomas

Seredostinnya, mediastinum, is a whole complex of organs that have grown in the breast emptying between the right and left pleural emptyings. In front, the middle is surrounded by a sternum; behind - with chest ridges; s side - right and left mediastinal pleurisy; in the middle of the middle, stretch to the upper aperture of the chest wall, below to the diaphragms (Fig. 247, 248). The middle ground is not symmetrical to grow in the sagittal area, but to look out into the link with the singing station of the heart of Organi, to become the middle, tied together with a thick cell.

The most important value is the midline to the front and back, mediastinum anterius et posterius. Rozdilyaє їх frontal area, cleverly held through the trachea and the root of the legends (div. Fig. 247).

Before organіv front seredostіnnya otnosyatsyaherdtse of the pericardium i cob great sudin, thymus zaloza (abo Inshyj analogіchny її in dorosloї Lyudin skupchennya zhirovoї klіtkovini) dіafragmalnі Nervi perikardіalna-dіafragmalnі sudini, vnutrіshnі grudnі krovonosnі sudini, okologrudіnnaya, perednі seredostіnnya i verhnі dіafragmalnі lіmfatichnі vuzli ...

In the posterior middle there is a trachea and head bronchi, stravochid, thoracic part of the lower aorta, thoracic lymphatic duct, unpaired and semi-unpaired veins, right and sometimes bloody and viscera

nerves, sympathetic stem storms, posterior middle, prevertebral, peri-tracheal, tracheobronchial and broncholegenic lymph nodes.

At the same time, the middle is cleverly divided into two sections: the upper middle and the lower middle. The cordon between them is carried out behind a horizontal clearing area, which passes from the lower edge of the sternum handle to mid-row disc mіzh IV and V chest ridges.

In the upper middle, mediastinum superius, the thymus lobe, the great atrial vessels, the bluish and diaphragmatic nerves, the sympathetic stovbur, the thoracic lymph duct, the upper part of the thoracic duct to the gravoduct are growing.

In the lower middle, mediastinum inferius, in its own right, they see the front, middle and back middle.

The anterior middle, mediastinum anterius, is spread between the sternum and the anterior part of the costal pleura to the back. Take revenge on the inner breast judge; pericardial, anterior middle and pre-cardiac lymph nodes.

Middle middle, mediastinum medius, vidpovidaє, like the heart with the pericardium, great atrial sudins and roots

lungs There also pass the diaphragmatic nerves in the superconductor diaphragmatic-pericardial vertebrae and there are lymph nodes root of the lung

Posterior middle, mediastinum posterius, 01 ranged0 wall of the pericardium in front, breastfeeding spinal stop with ribs backwards To the organs of the posterior middle, the thoracic part of the lower aorta is carried out.

3. Basal fodder nuclei of the brain. Internal capsule, localization, conductive paths.

middle [mediastinum(PNA, JNA), septum mediastinale(BNA)] - a part of the chest emptying, surrounded by the posterior surface of the sternum - in front, by the thoracic ridge ridge - behind, the right and left mediastinal pleurisy - on all sides, the upper aperture of the bottom of the breast plate - at the top and bottom of the chest. TOPOGRAPHANATOMІV viznachayut Mediastinum is a complex of organs that are rosted in the breast emptying between the right and left mediastinal pleurisy.

anatomy

Projection Seredostinnya in front of the sternum (without sword-like sprout), Back to the I-X (XI) chest ridge. A.A. Bobrov (1890), having propelled the mediastinum along the horizontal area, should be carried out through the upper edge of the III rib, on the upper and lower (mediastinum sup. Et inferius). At the lower middle there is a heart (div.) I pericardium (div.). Umovnoy area, scho pass frontally through the trachea and the head bronchi, S. podilayut on the front and back (mediastinum ant. Et post.). In some way, talk about the middle S. (mediastinum med.), Mayuchi on the trachea and head bronchi.

At the front S. ate (from the front to the back): vilochkova zalosa (div.), Abo zamenu її Klitkovin, upper empty vein and її turns - shoulder head and unpaired (chastkovo) veni (div. gilkami (div. Aorta), legeneviy stovbur (div.) і th gіlki, legenevі veni (div. Lungs), diaphragmatic nerves, limf. vuzli, trachea (div.) and head bronchi (div.); in the lower yogo viddili - heart and pericardium (color. Fig. 1). In the back S. roztashovani stravohid (div.), Limfi. thoracic duct (div.), thoracic part of the aorta (div. Aorta), unpaired and semi-unpaired veins (div. Vidnya), bluish nerves (div.), sympathetic stubs and thighs, thoracic aortic gossip (color. Fig. 2).

The lateral size of the upper and lower S. is larger, lower than the middle one. The anteroposterior size increases from top to bottom. Form S. to lie in the form of the breast cell (div.).

puff available fabric on, Navkolishnє organi S., є dinim tsilim. Along the mountains, you will go out of the retro and superior classrooms of the shia (div. Klitkovinni space), below - through the opening with diaphragms along the way along the eastern and paravasal klitkoviny - from the womb (div.). Naybіlsh swirls fluff with a full tissue on neatly anteriorly towards the ridge and beside the middle behind the handle of the sternum, naymensh - between the leaves of the mediastinal pleurisy (see) and the organs of the C. The retrosternal (retrosternal) space is located between the posterior surface of the sternum and the aortic arch. In a new roztashovani thymus zalosis and shoulder head veins, limf. universities, superficial extracardial nerves gossip. The pretracheal cellular space is located between the anterior surface of the trachea and the arch of the aorta, the upper empty vein and the leg arteries. Take revenge on extracardiac gossip. The right paratracheal spaces are enclosed by the sides of the trachea and mediastinal pleura, and in front of the upper empty vein. At the new one there is limf, vuzli, partial unpaired vein, right diaphragmatic and upper viddil of the thoracic part of the right bloody nerve (color. Fig. 3). In front of the paratracheal spaces of the medial trachea and stravohode. laterally - by the arch of the aorta, by the lateral sleepy and clavicular arteries. Vono vmіschuє partly lіvіy bloody nerve, thoracic duct і lіmphy, vuzli (color. Fig. 4). In the prefalculatory cellular space, formed backward by the trachea, in the front - the posterior surface of the trachea, and below the bifurcation - the posterior surface of the pericardium (this part of the space is called the posterior cardiac), the lymph grows out. vuzli. The backward cellular tissue space is located backward toward the stravohode. At the new level, the stravohode is nervous, gossip and limfi, vuzli. The posterior space is transformed into the paravertebral space, rostasovani from the sides and the thoracic ridges; they contain pretty stov storms, unpaired and half unpaired veni.

The innervation of the organs of the C. is healthy to the thoracic aortic gossip (plexus aorticus thoraci-cus) and the older ones - the heart (plexus cardiacus), stratochid (plexus esophageus) and the legacy pulpalis (plexus)

Blood endocrine S. can be found in numerous arterial spines, so take an ear of yak without the middle of the aorta - mediastinal (rr. Mediastinales), bronchialisalosis (rr. Bronchiales), periardial (rr. hylok - posterior intercostal arteries (aa. intercostales post.), from the internal chest arteries - medial, thymus (rr. thymici), bronchial thyroid glands. The appearance of venous blood appears in unpaired, semi-unpaired and in the inner chest vein.

Lymph, judging from the organs of S. go to the onset of the lymph, the nodes: close-sternum (nodi lymphatici paraster-nales), pre-cardial (nodi lymphatici prepericardiales), lateral pericardial (nodi lymphatici. vertebrales), front and back middle (nodi lymphatici medi-astinales ant. et post.).

X-ray anatomy

In a direct projection, think for X-ray anatomy S. mensh is friendly, because everything is organized in one intensive time. Brush umovi for rentgenol. until S. is set in oblique and general projections. On the roentgenogram in a normal projection, one can see a number of hearts and magistral vessels, which occupy the middle frame of the image of the breast (Fig. 1). Ahead from the center to the back of the sternum, there is a retrosternal space at the side of the light smog. Behind the backward of these heart and main vessels to the ridge, there is a retrocardial space at the sight of the illumination of the wrong striped form. The organ of the rear S. and the rear view of the leg are immediately displayed. In a person who is abducted, one can see a kind of low aorta.

For rentgenol. vivchennya is especially folding the upper part of the S., repaired from the level of the first mid-ribs, it is closed by the overlays of the joints, the shoulder girdle (belt of the upper kintzivka, T.) and to celebrate the great blood-bearing judges. Along the posterior edge of the vertebral cavity at the upper viddili, one can see the light of the trachea smog, which overflows the aortic arch. Umovna line, carried out along the back contour of the trachea, extend the upper S. to the anterior and posterior sides. In normі with zychayny rentgenol. doslіdzhennі stravohіd, limf, universities and nerves are not visible.

cleaning methods

When a sick person is obstinate, it is necessary to vrahovuvati, scho Patol. the processes that develop in S., summarize an important symptom complex - so sound. mediastinal syndrome: cyanosis, stagnation, damage to the heart, chest pain, swelling, exposure of the upper symptoms, enlargement of the pediatric veins of the chest and in. (div. medical syndrome). Other symptoms, which are for everyone S.'s illnesses, are identified and are related to the nature of the localization of Patol. the process of this sick person. So, S.'s gnіynі processes are supervised by a hot camp, high leukocytosis, lymphogranulomatosis is characterized by hematolo dynamics. zmin, for echinococosis - eosinophilia, positive reaction of agglutination with latex, Kasony's test. Inflow of peculiarities of localization Patol. to the process on a wedge, the picture is best cleaned with pukhlin S.

At rozp_znavanna Patol. S. processes are of great importance, such methods of follow-up, such as radiological, bronchological, surgical, etc.

Radiologic methods: mediastinography (div.), Pneumo-mediastinography (div.), Overlay diagnostics of pneumothorax (div.), Angiocardiography (div.), Contrast radiological diagnostics. Pneumo-mediastinografiya, and especially tomopneumo-mediastinografiya, allowing to correct the symptom of being covered with Patol gas. tіnі, viyaviti "nіzhku", as b tied a new solution from S., or the presence of extraordinary gas prodigies in yogo cells. Diagnostic pneumothorax, a cut can be applied when there is evidence of a large amount of pleural emptying, allowing for the appearance of a new solution from a swelling or a leg. More overconfused to give in to give up in case of new solutions that have been removed in the upper-posterior form of S. Angiocardiography and aortography may more important in differential diagnostics of new patients with S. and congenital anomalies of the arterial system, aneurysms of the leg stovbur and aorta.

The contrast of the empty veins is important for assessing the broadening of the swelling process in S., as well as the appearance of the hindering and germination of the swelling process.

By the highly effective method of S. є Computer tomography(Div. Computer tomography). Bronchological methods - bronchoscopy (div.) І bronchography (div.) - stasis for intrapulmonary localization of swelling or bone.

Surgical methods - biopsy of puncture through the chest wall or a bronchoscope, Mediastinoscopy (div.) Abo thoracoscopy (div.) arr. on rejection of new material for cytological or histological prescription and without the most accurate diagnostics. Puncture through the thoracic wall is useful in case of new decisions, to which they lie down to it. Through the bronchoscope, punctured in the main new solution, they go out from the adjoining to the trachea and the bronchi lymph, universities. Mediastinoscopy is a diagnostic operation, which is used for endotracheal anesthesia, allowing the development of revision of the anterior S. for an additional special endoscopic apparatus - mediastinoscopy.

Standard methods include fluoroscopy, roentgenography, tomography, and in case of pathology in the posterior S., radiopaque dosage to the stravohode (div.). Naykrashcha rentgenol. Documentation novoyotvoren S. is often reached not by radiography, but by electroradiography (div.). Accurate preoperative diagnostics is S.'s novostoren from їkh morfol. Verify not to be dependent on the use of special numerical methods until the end of the day. In cich vipadkah, the residual diagnosis will arise until the hour of the operation.

pathology

Pathology of S., including malformations of the development of S.'s organs, fired up, Kisti and pukhlini.

vices of development organs of S. develop on a regular basis (div. Aorta, Stravohid, Sertse).

pooshkojennya

Opening and closing messages S.

Zakriti pozhkojennya mozhut vinikati at important stuff for the depression of the chest wall, with severe fractures of the sternum, in some cases due to a backward contusion (div.). When S.'s injury occurs, the nature of the change lies mainly in the bloodstream in S.'s cell, because of the penetration of the disease and infection (when the bronchial tubes are open, the blood stream). Bloodstains and emphysema S. often win overnight.

With a small hematoma S. the bleeding should be mimicked. Sickness is small, bile at the breasts, light cyanosis, slightly swelling of the veins, which is spontaneous in the first 2-5 dB. with injuries, step by step. The development of large hematomas and imbibitions with the blood of organs and tissues of S. is especially not safe for the imbibition of the blood of the bloody nerves. Ostanniy often occurs with progressive mediastinal hematomas. Often, in some types of drops, the importance of malignant pneumonia (the so-called Vagus pneumonia) is spontaneous. The appearance of S.'s hematoma suppurates with the development of diffuse mediastinitis (div.) Or an abscess is formed. In case of great S.'s hematomas, it is shown the first puncture, the appearance of blood, and the introduction of antibiotics.

With the appearance of traces of mediastinal hematoma є cicatrix, growth, which can lead to sclerosis of the blood cells, nerve depression and nerve depression, mediastinopericarditis. In deyakykh vypadkakh vinikє perineurієm blukayuyushchy nervіv, scho to produce up to the rupture of secretions, motility and trophіki went. - kish. path.

Mediastinal emphysema is susceptible to the development of bronchial tubes, segments of the legends, Scho establish the media-wall surface, stravohode, before the retroperitoneal growth of the intestinal tract. Emfizema without a significant shift in a vice in S. zazvychay protykak asymptomatically (div. Pneumomediastinum). Progressive mediastinal emphyzema develops hl. arr. with internal valve pneumothorax (see). Winikak, with a lot of growth, zadishka, cyanosis, impaired blood circulation, growth of the infant's emphіzema of an individual, shia, breasts, rapidly burn down the camp of the sick person. Likuvannya - terminova puncture of pleural emptying and S. with post-aspirate aspiration, novocaine shiina vagosympathetic blockade, thoracotomy and suturing of bronchial opening.

When you see your child's wounds (wounded), your organs in peacetime you get sick when you see a breast cancer. The purchase of blood and blood clots in the early canal and cells of S. worms(Div. Torakoabdominalnoy pozhkogennya). Cyber ​​hematomas during the day, injuries of the great judge and infections occur in the same way as during close injuries of S.

The injury of the great judge tends to be caused by important symptoms of the depression of the organs of S. and, most often, it ends unpleasantly. Infection of the wound of S. viclikє development of mediastinitis, which is against the type of phlegmon or abscess.

A special group is stored with wounded S. (approximately 0.5 wounds). To navigate with the chance of a friendly interruption and a smooth start of the transfer of a third-party body in S. is not very common in the near-before information of a cell, a nerve restraint, a vessel and an organ of S.

Wounded S. can be superficially affected by bloody nerves and cute stools, hearts and sudins, bronchial tubes, thoracic ducts. Especially since it is so sound. syndrome of the upper empty vein, to-riy vinikє with a hematoma suppressed, thrombosis or a vein with a large or partial blockage (div. Porozhny veni). Lіkuvannya operatively - overlapping routine anastomoses or shuntuvannya plastic corrugated prostheses.

Boyovy pozhkodzhennya S., as a rule, to meet with penetrating wounds of breasts and ears of organs. Obshay of the first dolikars and the first lykarskoy additional help, given in the case of cich poodzhennyah, identical to that for penetrating wounds of the breasts. The nature of the qualified and specialized assistance, shown before the operational involvement, is to lie down in the middle of the day.

fired up- see Mediastinit.

Kisti and pukhlini

Before the examination of the X-ray examination of the brush and chickens, S. was diagnosed with deprivation during the pathological examination. Vprovadzhennya rentgenol. the method of getting into a wedge, practice allowed Ya. A. Lovtsky to use the wedge until 1908, to guard against 520 ailments from pathology S. The frequency of fluff and cyst S. to become 1-3% according to the weariness to all localization of fluff. The stench is sprinkled the same way often in choloviks and women; It is important to develop in a young and mature person. On the thought of V.R. Braitsev, most of them are referred to as congenital dysontogenetic new products (div. Dysontogenetic puffs). good guys and S.'s brush is meaningfully overpowering the evil ones.

For the tribute of L.A. Giterman and N.I. Malyukov, ailments with specific disorders of internal chest lymphatics, universities store about half of all ailments from S.

In a wedge, the practitioners of the most often develop the first puffs and brushes. The stench is more low in 90% of ailments with newly developed S.: retrosternal goiter - 17%, neurogenic swelling - 15% (in children up to 51%), teratoid development-8%, newly established thymus periosteum (Tim) - 12% - 7%, lipomi - 7%. Fibroids, hybernomas, hemangiomas and lymphangiomy are rarely detected.

For those who want to be able to direct Vichulis (AR Wychulis) from the Mayo clientele (USA): good bristles store 16.2%, thistle swelling - 21.7%, teratomy and dermoid bristles - 9.3%, neurinomas evil lymphomas - 10.1%.

Kisti. Whole pericardial bones are round, oval or incorrectly shaped subtle illumination, reminiscent of a glimpse or a jovtuaty glimpse of a child. The stench is caused by the destruction of the process of evil of the membranous lacunae in the zone of formation of the pericardial coelom (Div. Perikard). The size of the cysts is 4-5 cm in diameter, the stench of penetration, sometimes appears from the empty pericardium. The walls of the brush are in the middle of the mesothelium with cuboid or epithelial-like cells, and the calluses are covered with pleuroses. In 30% of the sick, a wedge, show when there are cyclical cysts in the daytime, in a reshti it may appear stupid b_l in the area of ​​heart, cough, sluggishness, and with cysts of great changes - strong pain and the most important symptoms, the depression of the organs of S. Rise of the chaste cysts, the development of a suppurative process in them, or a small amount of diagnosis, is very difficult. When differential diagnostics slid persh for all vyklyuchit aortic aneurysm (div.) I aneurysm of the heart (div.), And also pukhlina legeni (see), Dermoidna cystu (div. Dermoid), diaphragmatic grizzly (div. In the diagnosis of celiac cysts of the pericardium, it is more important to note that localization is characteristic of the lower form of the anterior S. (partly on the right), clear and simple contours, revealing a link with the pericardium on pneumo-mediastomas. With localization in the upper or posterior S., the differential diagnosis of cystic osteoarthritis is important, and often uncomfortable. The operation with a coelomic bone is awkward and is stored in a transpleural visible bone. The results are good.

In a group of bronchogenic (bronchial) cysts, enterogenic (esophageal and gastrogenic) cysts are also described. All the bristles are inborn and set up from the ectopic rupture of the primary intestine. In some cases, there are changes in the options for the budget, and for the revenge of fabric mental systemsі went. - kish. path. Tse rounded thin brushes, reminiscent of a thin viscous light. In some cases, there is a shelter in the bone, or more often with a new bone with a bronchial lumen.

Wedge, symptomatology of bronchogenic and enterogenic cysts (enterocyst) are often found in all sizes. Often a wedge, symptoms appear in the same childish and accumulation of pressure on the trachea, bronchial tubes, stravohode, great veins. Seryoznі accelerated kist - suppression with a further breakthrough їх in the enlightenment dikhalnyh nobles, Pleural and pericardial emptying, stravohid, bleeding from the wall of the brush, as well as the development of massive growths. As a result of the development of cancer in the clinic. In case of enterogenic, gastrogenic sprouts, cysts in conjunction with the secretory activity of the lobes can also be used to interrupt the stem with perforation or penetration into the susceptible organisms.

At rentgenol. Diagnosis of bronchogenic and enterogenic cysts is important for the role of development of localization in the posterior C.

Kisti forks are often seen with children. The stench can be a bit rosy on the shoulder, and it strangles at the upper aperture of the chest wall, leading to tracheal depression and destruction of the wickedness.

Likuvannya polyagaє at a well-known brush, before-swarm it is necessary to carry out the yakomog earlier.

Ehynokok S. grows rather risky, as a rule in case of deseminated echinococosis. Most often it is the enemy of S.'s cells and pericardium. M.Yu. Gilevich and V.S. Krishtopin described a sick person with a liver-me-diastinal form of an echinokok-goat liver, in which the migration of the liver in S. through a stravochid aperture of diaphragms was stimulated.

Diagnostics of S.'s echinokok is awkward, as it is the primary source of the disease in the diagnosis or the legacy. May the value of rentgenol. Dani, positive reactions agglutination with latex and Kasony test. Lіkuvannya - operatively (div. Ehіnokokoz).

Forecast for prompt operative treatment of cyst S. splendid.

Pukhlini. The development of good and evil chickens S. Klin, symptoms of good new creatures S. to lie down from the bagatokh chinniks - the rate of growth and the size of the chin, її localization, stages of health of the anatomical Perebіg more pukhlin S. in the cob period without symptoms. Symptoms can be found in cases of increased swelling and knitting from cymbals, pressures and ruining of S.'s organs, as well as the tissues and organs of the breast that are lying close to them.

There are two main syndromes in S. pathology: compression and neuroendocrine. The stage of the manifestation of a compression medial-mental syndrome lies in the form of localization (anterior or posterior to S., central or marginal growth), the formation and intensity of growth, goodness or malignancy to the process. In case of edge shaping and to the main adult pukhlina trivial term may not appear. Naybilsh frequent symptoms of significant growth of Patol. Illuminate to serve as a witness and grip behind the breastbone, as well as a dull beard. Behind it there are signs of the deterioration of the function of the quiet organs of S. as a result of this compression.

There are three types of compression symptoms: organ (repair and health of the heart, trachea, head bronchial tubes, duct), loins (pressure of the brachial veins, thoracic duct, repair of the arch of the artery , cute Stovbur). Nybilsh often with neurogenic puffins, neurol appears. symptoms (bile, hyperesthesia or hyperesthesia, vegetative breakdown), syndrome of the upper void vein with swelling of the anterior viddil of the upper S.

Neuroendocrine syndrome manifests itself in lesions of the slopes, scho nagadu rheumatoid arthritis(Div.), And also to the defeat of the great and small tubular cysts - Bamberger syndrome - Mary (Div. Bamberger - Mary periostosis). There are changes heart rhythm, Angina pectoris (div.).

Stretching out the new solution S. razr_znyayut two periods - asymptomatic and period z wedge, openings. Good chickens develop asymptomatically for a trivial hour, in some rock and in ten years.

Diagnostics Pukhlin S. is very difficult. At the same time, in the first place, there are various processes (swollen and ignited) in the pleural emptying, segments of the lungs, lying down to S., thoracic stance, as well as the seizure of S.'s organs, diaphragms, thyroid cavity, to S. (aortic aneurysm, heart, diaphragmatic hernia, retrosternal and intrathoracic goiter); in a different way, vstanovlyuyut the nature of the chubby process (good or bad); thirdly, on the basis of the analysis of clinical and radiological features of the disease, specify the type of chubby.

The neurogenic puffs of S. are found on the basis of the conservation of the membranous elements, which took the nerves and the sheaths to settle. Most of the chubby grows from a pretty stovbur and intercostal nerves and grows in the back S., more precisely, in the costal-spine depletion (Legeneva Borozna, T.). For morfol. structures of neurogenic chills can be buty zneurinoma (div.), neurofibromas (div.), ganglion neuromas (div.). Pheochromocytomy (div.) І chemodectomy (div. Paraganglіomi) are reported up to the number of children S. pukhlin.

With neurogenic swelling, the symptoms are more swelling, less with all those rosy new-born babies. Tsі zmіni kindly restruyutsya for the help of Minor probes (div. Potovidіlennya). Bernard - Horner syndrome (div. Bernard - Horner syndrome), signs of compression of the vocal laryngeal nerve and in.

X-ray neurogenic chickens are characterized by a homogeneous intensive oval or rounded tine, tightly tied over the ridge. It is important є also a symptom of pleurisy, which is shown on tomograms. The grip of the chubby on the adjacent knuckles is set up to the widening of the mid-ridge openings, the appearance of the patterns on the ribs and ridges.

Ganglioneuromas can appear in the form of an erythematosus, as a part of the chickens grows in the spinal canal and is found in a higher place with chuck in C. spinal cord(Div.) Right up to parallels. Pukhlini, scho to resemble a bloody and swivel laryngeal nerves, They start to sound sarcastic, supravodzhuyutsya hoarse voice. Likewise, rіdkіsnі swelling of the phrenic nerve. In a number of ailments, neurogenic pukhlini S. is diagnosed as manifesting neurofibromatosis (div.).

Likuvannya - promptly. Standard operative access for visualization of neurogenic pukhlin S. є bichna thoracotomy (div.). In case of puffins of the type of sandy year, thoracotomy and laminectomy (div.) Are used for one-hour vision of the new solution from the S. and spinal canal (ridge canal, T.).

Z pukhlin of mesenchymal activity is more often promoted by lipomi (div. Lipoma), older fibromi (div. Fibroma), hemangiomy (div. Hemangioma), lymfangiomy (div.), Ost. ) і hybernomy (div.). The skin of such puffs is not often seen, ale sumarly stench pretends to fill a large group.

Lipomi in large families are spared from women who are sick to the touch. Typical localization of a lipom - right cardiodiaphragm-miniature kut, if the stench can grow in some C. in S. and in the organs of the thoracic cell), parasternal - mediastinal (to grow at the viglyadi of the chickweed in the anterior S.).

The chubby grows by and large, and only when the size is much wider, or when the two-sided widening is used to produce the life of important organs and suckers of breast emptying until the end of life. Malignancy їх is denoted in the edge of the country.

Roentgenol. the picture with lipoma of the cardiodiaphragmatic cut is characterized by a round tone, which is adhered to a tone of heart, diaphragms and anterior chest wall. Differential diagnosis between lipoma S., coelomic cyst of the pericardium and diaphragmatic cyst of Larrey (div. Diaphragm) is carried out in the main for additional application of pneumo-mediastinum: gas is discharged to the lipome and rosharov ї on the small pieces. The whole symptom of frequent and viscousness of the smallness, as well as the diaphragm, pathognomonic for the type of S.

Yak and all S. pukhlini, lipomi, as a rule, are seen. However, with a typical rentgenol. the picture and the appearance of the wedge, having shown it is permissible to be unsettled during the operation and being intertwined by the well-known rentgenol. control. The operation of technically awkward significant difficulties, behind a vignette, is a visible chuck in the form of a sandy year, with some of the required two-sided or combined access.

Fibroma S. to try to finish it ridko. Most often, the chickens are localized in the anterior C. The stinks are seen from the fibrous plaques of the pleura, pericardium, stroma of the thymus root and in. The size is small (4-5 cm in diameter.), The consistency is thick, the shape is round, the fluff is encapsulated. Wedge. Stretching out with a charm. With small sizes of puffiness, the symptoms are few. The reduction of chubby can lead to the reduction of a pretty stove and the development of Bernard-Horner syndrome. Vidalennya chubby, as a rule, lead to oduzhannya.

Sudinni pukhlini S. lymfangiomi, hemangiomi - grow very seldom. Їх preoperative diagnostics is very important. G_stol. Budova does not grow out of Budov and the damn chickens of the localization. Likuvannya - promptly. The forecast, as a rule, is friendly. Cystkovi (osteomy) and cartilages (chondromias) of S.

Castleman (V. Castleman) having described the occasionally serious illness - ganglionic hyperplasia of lymphatic universities S. (angiofollicular lymphoid). Plasmacytic (bl. 10%), vascular-hyaline, lymphocytic (up to 90%) and changes in industrial form are observed. Pukhlini squeak out ovoid or spherical shape, great roses, Вміщені. Likuvannya polyagaє in a well-known urazhenoi lymphoid fabric, dear, unimpressed on those poohlina, it is encapsulated, which is one of the only difficult ones in connection with the clarification of vascularization. No relapse.

For the designated puffs of thistle zalozi (div.) Zbirny term "thymoma" is stagnant. G_stol. Budova Timom is even more profitable. Vyavlyayutsya at g_stol. Prescripts of adulthood (goodness) often do not show tendencies to infiltrative growth, metastasis and relapses after being seen. Everything Tim needs to respect the potentially evil puffins. Smell the stench is a great, wrong form of swelling, which is localized, as a rule, in the upper or middle form of the front S. When rentgenol. most recent diagnostic value May pneumomedicastinography and point-Zion biopsy through the chest wall.

From the help pukhlin - Timom - a step towards the development of hyperplasia of the thymus, the edge of the vine in children and grown-ups in case of damaged processes of fiziol. іnvolutions.

Puffy thymus may develop with the Isenko-Cushing syndrome (div. Icenko-Cushing's ailment) and lesions of the thyroid cavity (div.).

Wedge, with a hold of Tim, beckon not to see out of the middle of the pukhlin S.

Likuvannya Timom operatively. Zvychay vikoristovuyt intercostal access on the sides of the striking. With the middle growth of puffiness and great sizes, a later growth of the sternum is shown. When Tim and Mystenia (div.) Symptoms of myazoi weakness are detected, the visible chickens are slow to pass. In the case of hyperplasia of the thymus, the wedge does not turn rapidly, hormonal or exchange therapy is used with manifestations of the myasthenia.

The retrosternal goiter can also be carried to S.'s pukhlin, from a look at the topography. I see three types of retrosternal goiter: "pirnati", a large part of which grows in S., and mensha - in shi, vistupaє when kovtannі; vasne retrosternal goiter, which is localized entirely behind the sternum (the upper yogo pole can be felt behind the virid handle of the sternum); intrathoracic - retouching gliboko in S. and inaccessible to palpation. Tsi vidi retrosternal goiter may grow wedge, perebig. So, "parnatie" goiter is characterized by periodically advancing manifestation of asphyxia, tied to the deviation of the trachea, as well as symptoms of pressure on the trachea (dysphagia). With retrosternal and internal chest goiter, there may be symptoms of depression of the great sudins, especially the veins. In cich vipadkas, there is a swelling of denunciations and swelling of the veins, blood in the sclera, enlargement of the veins of the chest and breast. Venous grip in cichors with ailments, headaches, weakness, and weakness are prevented. In the diagnosis of retrosternal and internal goiter, there is a very large amount of fluoroscopy. To confirm the diagnosis of the radio-isotopic scan of 131 I, even the negative data of the previous development does not involve the manifestation of a "cold" or coloidal university.

Retrosternal and intrathoracic goiter, bordering the trachea, the trachea and great venous stovbury, can become malignant, so the early radical visualization of it is obovyazkovym. The retrosternal goiter is seen from the back access, and the intrathoracic - from the lateral intercostal access of abnormal growth in the back of the lateral lateral or late-transverse sternotomy.

Teratoidnye svіty S. was taken up to pukhlin, vrahoyuchi їkh morfol. the structure and the possibility of malignization (div. Teratoma). The stench may look like solid or cystic apparatuses (Fig. 2). With suppuration of dermoid bristles (div. Dermoid) instead of old, pus-like. Perebig dermoidnykh kist S. trivialy. The size of the brush grows more and more. The pathognomonic sign is vikashlyuvannya kashko-like mass and hair (when the brush is drawn in the bronchus), in all of the other dummies, it is easy to develop.

With rentgenol. preliminarily innocent, the shape of the brush has been adjusted to the contour of the brush. Yu Yu Dzhanelidze in 1947 describing so sound. pseudoaneurizmatic form of dermoid brush S. At rentgenol. preliminaries of such pulse pulses, and with auscultation, the prevention of systolic murmur develops.

Malignancy of teratomas, which is indicated in 8-27% of cases, supervises a wedge, symptoms.

Differential diagnosis is carried out with cysts, abscess and cancer of the legacy, chubby breastfeeding, Exudative pleurisy, aortic and heart aneurysm.

Shown to the visible teratomas of S. are placed widely through their scholarship to a small extent. Vikorinennya pukhlinya is carried out from the mid-ribs access or by a path of the middle late development of the sternum. Difficult, how to be seen in the presence of chicks, poohlin, pole in I can see capsules, tight links with the root of the legend, great judges, organs of C. With teratomas without signs of malignancy promptly involved yes, there are no more results.

Malignant poohlini S. can be primary and metastatic. H Parvin puhlin perevazhayut mediastinal form lіmfogranulematozu, lіmfo- i retіkulosarkomi, zustrіchayutsya sarcoma klіtkovini C. (i Fibro- lіposarkomi, zloyakіsnі gіbernomi mezenhіmomi i) nezrіlі sudinnі puhlini (angіosarkomi, angіoendotelіoma Gohmann i-gіoperіtsіtomi) zloyakіsnі neuromas (neuroblastoma) puhlini thymus and teratoma-blastoma. Carry out a read between the nearby good and evil pukhlin S. at the presentation of morfol. It’s not always possible, but there’s a little bit of immature chickens in a child’s life. However, in children, it is more important to have a large amount of unclean chicks, to which 23.9% of children are ill with chills and cysts of S., who are malign or potentially malignant.

Oprominennya to carry out on gamma-therapeutic devices (div. Gamma-device) and linear prikoruvachi elektroniv (div. Prikoruvachi charging particles). Stagnation of the anti-winter fields, the configuration of which took to lay down in the course of the battle and set up individually at the skin ailment for help screening the blocks. One-time vognischeva dose to become 200-220 radium (2-2.2 Gy), tiznev (5 sessions) - 1000-1100 radium (10-I Gy). When the dose is reached, 2000 rad (20 Gy) is expected to indicate a delay in the optimization for the implementation of the therapy effect. Pislya tsyogo on the submission of repeated rentgenol. to form fields of smaller sizes. The total focal dose should be increased to 4000-4500 rad (40-45 Gy), and in some cases (with lymphosarcoma) up to 5000-5500 rad (50-55 Gy).

In case of cancer of the stravohode and legends with metastases in the lymph, the universities of the S. of the field are optimally shaped up to the top. The total vognischeva dose with a radical course becomes, as a rule, 6000 rad (60 Gy), with a paliative - 4000 rad (40 Gy). A try to carry out exchange therapy is possible in case of primary sarcoma of cellvine S. The main accelerated exchange therapy is pulmonitis (div. Pneumonia), exchange fibrosis, pericarditis (div.).

Combined Likuvannya evil new creatures S. can be planuvati deprived with malignant puffs of thymus zolozi, or in rare cases with retrosternal goiter.

With all good new solutions of S., a more early radical operation is shown. Vinyat to shake off only with new solutions of the right cardiodiaphragmatic cut (coelomic cyst of the pericardium, mediastinal lipoma) when there is a wedge, symptomatology and tendencies to increase Patol. тіні at rentgenol. doslіdzhennі. For such ailments, it is possible that there is a dynamical watchfulness with a shorny rentgenol. control.

In case of malignant puffs, S. is shown before the operation, due to some factors, and in the first place - widening and morfol. features of the process. Build a small part of the picture of the evil chubby S. In addition, the change in the mass of chickens will open up the mind for a further optimization and chemotherapy.

The prototype before the operation is to start a severe illness of the sick person (extreme weakness, the appearance of a pechinkova, nirkov, a legacy-heart deficiency, but it does not seem to be a therapeutic infusion), for signs of obviously inoperability (obviously

Forecast to lie in the form of puff and freedom of the conducted treatment.

operations

Operations in the middle in the day of breaking up to do good. I’m able to override the retinal peredoperats_yne obeshennya, scho will ensure the correct vibration of the operative access to S. - transpleural or late through the sternum (div. Mediastinotomy). When an indication is established before the operation, the guilty is made by the energy manager before the operation, as well as the individual characteristics of the sick person's organisms and the nature of the changes in the organs, which are viciously developed by the Patol. process. A special respect is guilty but it is attributed to the sanitation of the empty company and the nasopharynx (nasal part of the pharynx, T.) and the disease of the heart and legends. With the presence of an ignition process in S., antibiotics are introduced in a relatively short hour and intensively.

The rational method of antibiotic therapy is a combination of endotracheal anesthesia and muscle relaxants. In okremikh vipadkah mіssevuyu anesthesia іnfіltratsіynoi for Vishnevsky.

It is promptly shown in case of pukhlins і cysts S., as well as with gostrich mediastinіt і aliens ah S., scho suprovodzhuyutsya hron. firing process, Pain or hemoptysis.

On special respect merit two surgeries: seeing the great retrosternal goiter only for the sternum access, i.e. without sternotomy, or thoracotomy (for vivedenny goiter with the thoracic emptying on the shii, it is necessary to corrode with the same overlays on the institute of the seam); visualization of paravertebral neuroma

in the form of a sandy year with two accesses - a standard bichesky thoracotomy and lakhminectomy.

The results of the operative visualization of pukhlin і cyst S., as well as third-party til S. in the backward friendly. The operational lethality of the warehouse is 2-4%.

Vishnevsky A. A. i Adamyan A, A. Khirurgiya middle, M., 1977, bibliogr.; Holbert 3. V. and Lavnikova G. A. Pukhlini and the Middle East, M., 1965, bibliogr.; Elizarovskiy S. І. that Kondrat'ev G. I. Atlas "Hirurgic anatomy of the middle", M., 1961; Isakov Yu. F. and Stepanov EA Pukhlini і brisket sternum in children, M., 1975; Korolov B.A., Korepanova N.V. and Shabaev N.G. goodness new middle, breast. хір., No. 1, p. 101.1974; stench f, Teratodermoidi mediostinnya, Khirurgiya, no. 8, p. 104, 1978; Krotkov F.F., Purizhanskiy I. І. і Korsunsky V. N. Diagnostics of malignant new products with vicories 111 In-bleomycin, Med. radіol., t. 25, no. 12, p. 28, 1980; Krotkov F.F. CLINIC ASSESSMENT deyakikh tumorotropic radio-pharmaceutical preparations, ibid., vol. 27, no. 10, p. 42, 1982; Kuznetsov I. D. і Rosen-Strauch L.S. Luk'yanchenko B.Ya. Bagatotomne book of surgery, ed. B. V. Petrovsky, t. 6, book. 2, p. 488, 536, M., 1966; Dosvid of Radianskoy Medicine at Velikiy Vіtchiznyanіy vіynі 1941-1945 pp. V. 9, p. 424, M., 1949; Osipov B.K. Translator N. I. Klinichna chemotherapy of chubby zhvoryuvan, M., 1976; Perelman M.I. and Domrachev A.S. хір., t. 103, no. 10, p. 14, 1969; Pereslegina. A. Promeneva therapy of evil poohlinnyh middle, M., 1959, bibliogr.; Petrovsky B.V. Petrovsky B.V., Perelman M.I. and Domrachev A.S. 88, 1969; Suvorova T.A. Puffy and middle brush, breast. хір., No. 3, p. 133, 1968; Kutiv F.G., Seleznyov E.K. and Іgnatyev A.S. he-col., vol. 17, no. 7, p. 21, 1971; Hirurgic anatomy of the breasts, ed. A.N. Maksimenkova, p. 143, L., 1955; Angeletti C. A. a. o. Classification and distribution of mediastinal tumors and cysts, Surg. in Italy, v. 9, p. 248, 1979; Bariety M. et Coury Ch. Le medias-tin et sa pathologie, P., 1958; Baudesson D., Borrelly J. et Duprez A. Hyperplasie ganglionnaire geante du mediastin, Ann. Chir., T. 34, p. 619, 1980; Edwards C. L. a. Hayes R. L. Tumor scanning with 67Ga citrate, J. nucl. Med., V. 10, p. 103, 1969; Gelrud L. G., Arseneau J. C. a. Johnston G. S. Gallium-67 localization in experimental and clinical abscesses, Clin. Res., V. 21, p. 600, 1973; Hasse W. u. Waldschmidt I. Medi-astinaltumoren im Kindesalter, Zbl. Chir., Bd 92, S. 573, 1967; Merlier M. et Eschapasse H. Les goitres k deve-loppement thoracique, P., 1973; Rubush J. L. a. o. Mediastinal tumors, J. thorac. cardiovasc. Surg., V. 65, p. 216, 1973; Sabi st on D. C. a. Scott H. W. Primary neoplasms and cysts of the mediastinum, Ann. Surg., V. 136, p. 777, 1952; Tondury G. Angewandte und topographische Anatomie, Stuttgart, 1970; Wychulis A. R. a. o. Surgical treatment of mediastinal tumors, J. thorac. cardiovasc. Surg., V. 62, p. 379, 1971.

B. V. Petrovsky; G. D. Baysogolov (glad.), R. I. Gabunia (radioisotope diagnostics), S. S. Mikhailov (an.), A. I. Pirogov (ONK.), I. X. Rabkin (rent).

middle- a whole complex of organs, straightening between the right and left by pleural beads. Anteriorly, the middle is enclosed by the sternum, posteriorly - by the thoracic tip of the spinal stump, from the sides - by the right and left mediastinal pleura. At the height of the middle, stretch to the upper aperture of the chest wall, below - to the diaphragms.

In the middle of the surgery, there is the front and back. Cordon mіzh vіddіlamy - frontal area, held through the trachea and the root of the legends. In the anterior middle, the heart grows out of the middle and falls into the middle of the great vessels, pericardium, aortic arch, thymus, diaphragmatic nerves, diaphragmatic-pericardial blood vessels, inner middle thoracic blood-bearing vessels, pericardial In the posterior middle there is a stravochid, thoracic part of the aorta, thoracic lymphatic duct, unpaired and semi-unpaired veins, right and sometimes bloody and visceral nerves, sympathetic stem storms, posterior middle and prevertebral lining.

Behind the International Anatomical Nomenclature, the middle extends to the upper and lower, between them - a horizontal area, drawn through the back of the handle from the trough of the sternum in front of and the mid-spine disc between IV and V by the thoracic ridges. In the upper middle, the thymus grows, the right and left of the shoulder vein, the upper part of the upper empty vein, the arch of the aorta and goes out of the vessel (brachiocephalic, late trachea, and the lower part of the neck), the artery ducts, right and left sympathetic stovburiv, bloody and diaphragmatic nerves.

The lower middle, in its own circle, grows to the front, middle, back. Anterior middle, lying between the middle of the sternum in front and the anterior wall of the pericardium at the back, to replace the inner sternum (arteries and veins), near the chest, anterior middle and anterior cardiac lymphomas. In the middle middle, the pericardium is located with the growth of a new heart and the intracardiac diseases of the great blood vessels, the head bronchi, the leg arteries and veins, the diaphragmatic nerves with the supervascular periochronic phrenic-vascular The posterior middle is surrounded by a wall of the pericardium in front and a ridge stop behind. To the organs of the posterior middle, the thoracic part of the lower aorta, unpaired and semi-unpaired veins, appearing from the left and right sympathetic stings, internal nerves, middle protruding nerves, antepartum

Into the space of the breast emptying

The cellar space of the breast emptying is added to the walls (behind the breastbone, above the diaphragm, at the ridge and on the small walls of the breast cancer) and on the anterior and posterior mediastinal.

Pristinkov_ fiber space

parietal cell It is also called Extrapleural, pidpleural, posterior pleural. You can see chotiri areas of the parietal cell.

The area of ​​the upper ribs and the dome of the pleura - appear in the apparent sign of the fluffy cotchinoid, which allows the pleura to be visible.

Another area is expanded by 5-6 cm to the right і towards the ridge. Wonderful twists and turns of the ball of fluffy klitkovini and without sharp between go into the offensive area.

The third area is from the bottom of the IV rib to the diaphragms and in front of the transition of the ribs to the rib cartilage. Here, the puff of Klitkovina is weakly rotated, since the parietal pleura is seen from the intrathoracic fascia, which requires a mother for breast surgery.

The fourth area of ​​the rib cartilage, the little ones in the mountains (up to the III rib) є the significant ball of the fluffy cotchino, and right down to the bottom of the cottokin, because of the fact that the parietal pleura is here mintly spliced ​​with the fibers of the transverse ligament of the thoracic right side of the tongue - -diaphragmatic vertebral beam.

Retrosternal cellular space- a ball of fluffy klitkovini, alternating in front - fascia endothoracica, from the sides - mediastinal pleurisy, backwards - to the extended leaf of the fasciasis (fascia retrosternalis), growing from the sides of the fascia in bunches, which endothoracic There are one pair of parallel lymphatic universities, the inner thoracic vessels go out from them by the front inter-ribbed knobs, as well as the front mid-ribbed ones.

Klitkovina retrosternal space is seen from the cellular spaces by a thin leaf of the power fascial sheath, so that it is attached to the inner surface of the sternum and cartilage of the I-II ribs. From the bottom of the retrosternal cell line to the pidpleural cell line, which will store the width between the diaphragm and the ribs down to the costal-diaphragmatic sinus of the pleura, so called the fat folds Lyushka, which fills in the base in front of From the sides of the fat folds Lyushka can see the crest up to 3 cm in height, gradually changing, reaching the anterior groin lines. The purchase of adipose tissue on the upper surface of the sterno-costal tricycle with diaphragms is a great success. Here klіtkovina chevrіє navі in that vipad, if tricytnikіv swerving is not. The retrosternal fiber space of the enclosures is not visible from the cell spaces and the front and back mid-lengths.

Prevertebral cellular tissue space roztashovuutsya between the ridge stop and the intrathoracic fascia; it is filled with a small amount of fibrous fabric. The prevertebral cellular tissue is not extended to the same cellular tissue space. shiiny viddil the pre-vertebral space of interconnections on the level of II - III of the thoracic ridges to the attachments of the pre-vertebral joints and the pre-vertebral fascia, I will fit cases for them.

In front of the intrathoracic fascia, the parietal prevertebral space is developed, so that a particularly richly fluffy cotchinoid in the area of ​​the paravertebral grooves is avenged. Extrapleural cells from both sides appear out of the posterior middle by fascial plates, and go from the medial pleura to the anterior surface of the thoracic ridges, - pleurisy-vertebral ligaments.

To the open space of the front middle

Fascial case of thymus For the fatty tissue (corpus adiposum retrosternale), it grows in the anterior middle most of the surface. A case of allegations with a thin fascination, through the yak, zazvychay enlighten the speech, zalozi. Fascial case with thin fascial arches of dressings with the pericardium, mediastinal pleura and fascial arches of the great sudins. The upper fascial spines are well-rounded and include blood-bearing judgments. The fascial sheath of the thymus gland is the upper interpleural field, the size and shape of which lie in the type of bud and thoracic clitini.

Upper and lower Interpleural fields may be seen in tricutniks, with one to one vertex. The lower Interpleural field, rosted down to the bottom of the IV rib, varies in its sizes and often grows along the middle line. The size and shape of the sternum lie in the size of the heart: with a large and transversely expanded heart, the lower interpleural field appears to the entire length of the sternum stretching IV, V and VI intercostal spaces; with a vertical roseta of a small heart, it borrows a small amount of the lower edge of the sternum.

In the inter-field of the anterior wall of the pericardium, up to the retrosternal fascia and the fibrous ball of the pericardium and the fibrous ball of the pericardium, the fibrous appendages are established, describing the ligament of the pericardium.

The order of the type of breast tissue for the form and size of the upper and lower interpleural spaces is also important for the development of fat cells in humans. Navigate to the point of maximum proximity of the pleural bears on the level of the III ribs The interpleural distance of the reach is 2-2.5 cm with a weight of 1.5-2 cm in fat. According to the facts, the form and the value of the interpleural fields vary, but it is much more practical in case of operative access to the heart and the great vessels of the anterior middle.

At the upper part of the front middle, near the great Sudines, fascial cases, Scho є prodovzhennymi fibrous ball of the pericardium. In such a fascial case there is an extracardiac part of the arterial (botallova) duct.

The names of the fascial cases of the great Sudins are the fat cells of the anterior middle, which are the supernumerary cases of the Sudin and at the root of the legacy.

Kltkovina front middle I drain the trachea and bronchi, making it fit into the tracheal spaces. The lower interface of the tracheal tissue space is set up by the fascial sheath of the aortic arch and the roots of the lung. The navkolotracheal cellular tissue space is closed on the pivots of the aortic arch.

To the bottom of both bronchial tubes є fascial-cellular tissue gap, filled with adipose tissue and tracheobronchial lymph nodes.

In navkolotracheal cellular tissue space, blood-bearing vessels, lymphatic universities, bloody and sympathetic nerves, there are extraorgan nerves gossip.

Fascial-cellular apparatus of the root of the lung performances with fascial cases of Legendary sudins and bronchial tubes, otochennaya on the whole protrusion with leaves of visceral pleura. In addition, the anterior and posterior lymphatic nodes and nerves of gossip are included in the pleural-fascial sheath of the lung root.

From the anterior and posterior surfaces of the root of the lung, the pleural leaves go down to the bottom and attach to the diaphragmatic fascia on the cordon of the mucous and tendon part of the diaphragms. Formed by such a rank, the ligation ligatures (lig. Pulmonale) cover all the slit-like space from the root of the lung to diaphragms and stretched across the inner edges of the lower part of the lung and the middle. In a number of vypadkіv fibers of the legacy link pass into the adventitіsіy of the lower empty vein and into the fascial case to the stravohode. At the fluffy cells between the leaves of the legendary link, there is the lower Legeny Vienna, where there are 2-3 cm of the lung root components (up to 6), and the lower lymph nodes.

Klitkovina front middle does not go into the rear middle, so as the stench comes from one kind of swirling fascial devices.

Klіtkovinnі spacious rear middle

Around the pathway to the fiber space it is surrounded in front of the predishageal fascial, behind - the posterior fascia and from the sides - pristinkovy (mediastinal) fascia. From the stravohode to the walls of the fascial bed, pass the fascial vidrogs, in which the blood vessels pass. On the left side of the pathway, the extension of the retrovisceral cell line is located at the upper end of the ridge between the ridge stop and the strato-duct, and at the bottom - between the lower part of the aortic arch and the strato-duct. With a whole cell, they did not descend below the IX-X chest ridges.

Prostheses on the head and the wider pharyngeal-spine fascial vidrogs, which open the posterior-pharyngeal space of the children, triple and go into the sternum. Here the stench of groaning and priplyuyuyutsya evil to the fascial cases of the aorta, and on the right - to the prevertebral fascia. There is a fluffy cell on the left-hand side of the space, besides the flabby nerves and gossip, the venous gossip on the way.

Fascial sheath of the lower thoracic aorta of the statements behind the posterior aortic fascia, in the front - the posterior fascia, and from the sides - the mediastinal pathology of the parietal fascia. Here the thoracic lymphatic duct and the unpaired vein avenge, and the half-unpaired vein and the great cranial nerves are the closest to the diaphragms. Food, tobto in the upper parts of the breast, all the time they set up their powerful fascial cases and soothed with a larger or smaller amount of fluffy or fatty cells. Most of the cells are located near a lymph duct and unpaired veni, least of all - near a cute stove and black nerves. Klitkovina near the thoracic lymph duct and azygos vein is permeated with fascial vidrogs, which go from the adventitia to the fascial cases. Particularly good curves are in the near-aortic cells.