It houses the primary organs of the cardiovascular and respiratory systems, such as the heart and lungs, but also includes organs from other systems, such as the esophagus and the thymus gland. The thoracic cavity is lined by two types of mesothelium, a type of membrane tissue that lines the ventral cavity: the pleura lining of the lungs, and the pericadium lining of the heart.
The abdominoplevic cavity is the posterior ventral body cavity found beneath the thoracic cavity and diaphragm. It is generally divided into the abdominal and pelvic cavities. The abdominal cavity is not contained within bone and houses many organs of the digestive and renal systems, as well as some organs of the endocrine system, such as the adrenal glands. The pelvic cavity is contained within the pelvis and houses the bladder and reproductive system.
The abdominopelvic cavity is lined by a type of mesothelium called the peritoneum. Learning Objectives Describe the major cavities of the human body. Key Points The dorsal cavity contains the primary organs of the nervous system, including the brain and spinal cord.
The diaphragm is a sheet of muscle that separates the thoracic cavity from the abdominal cavity. Special membrane tissues surround the body cavities, such as the meninges of the dorsal cavity and the mesothelium of the ventral cavity. The mesothelium consists of the pleura of the lungs, the pericardium of the heart, and the peritoneum of the abdominopelvic cavity. Topographically, this first point corresponds to corpus of 6th cervical vertebra.
Anterior and posterior esophageal walls become closer in hyperflexion, and this partial narrowing point occurs. Third narrowing is one of classical narrowings made by aortic arch. This point corresponds to 4th thoracic vertebra topographically and measures 1. Point is located Fourth narrowing third classical narrowing is located at crossing point of esophagus and left main bronchium.
This point is located at level of 5th dorsal vertebra, and Fifth narrowing point is formed if patient has atrial dilatation caused by mitral stenosis. This point is located just below bronchial narrowing. This point is located at plane corresponding to upper edge of 10th dorsal vertebral corpus. Laimer narrowing occurs in situation of aortic atherosclerosis. Last narrowing and 4th classical narrowing is made by esophageal hiatus that originates from right crus of diaphragm, and is located at the level of 11th dorsal vertebra and 40 cm after maxillary central incisor teeth; it is 1—1.
When a person is not eating, esophageal lumen is closed above lower esophageal sphincter. Esophagus is primarily median and vertical, but has three slight curves located in neck, behind left bronchus, and at bifurcation of trachea Picture 1.
Endoscopic view of esophagus with the permission of Turkish Surgery Association. Esophagus is located at left of midline at level of 1st dorsal vertebra, right of midline at level of 6th dorsal vertebra, and left of midline again at level of 10th dorsal vertebra.
These narrowings and curves are important landmarks for radiological and endoscopic investigation of abnormalities, cancer diagnosis, and stricture formation after swallowing of chemicals [ 2 , 7 ].
Esophagus is anatomically divided into three parts: cervical esophagus, thoracic esophagus, and abdominal esophagus. Cervical esophagus starts at inferior margin of cricoid cartilage that corresponds to corpus of 6th cervical vertebra.
Cervical esophagus ends at inferior edge of first dorsal vertebra that comes up to a horizontal plane of jugular incisura of sternum. The endpoint is the starting point of upper mediastinum, and from this point it is thoracic esophagus.
Cervical esophagus is 5—6 cm long, and its luminal diameter is 1. Esophagus runs in deepest fascial plane of neck, leaning between trachea anteriorly and vertebra posteriorly. Esophagus is attached to prevertebral fascia by sagittal septa, which forms retropharyngeal and retro-esophagial spaces. Esophagus is covered by larynx and trachea anteriorly Figure 3 , but this covering is partial, and an open margin is found on left anterior side, which provides natural surgical access.
Esophagus attaches with tracheoesophageal muscle fibers to trachea; it is easy to separate tracheoesophageal plane, except in pathological circumstances. Inferior thyroid artery, thyroid lobes, and recurrent laryngeal nerves are other important contiguities of esophagus, and ductus thoracicus lies on left side of it. Esophagus connects prevertebral muscles, cervical vertebras, and prevertebral laminas posteriorly.
Placement of esophagus relative to other anatomic structures with permission of Turkish Surgery Association. Sagittal septa, which forms retropharyngeal and retro-esophagial spaces, blocks the diffusion of abscess of this area to upper mediastinum, but abscess can diffuse via pretracheal space to the upper mediastinum and can cause a fatal complication. Pretracheal space is important in that it can be perforated, primarily during an esophagectomy.
Recurrent laryngeal nerve RLN lies in tracheoesophageal sulcus, and esophagus is close to this nerve, which is important in case of cervical esophagectomy. Injury of RLN causes unilateral difficulty in swallowing and hoarseness; bilateral injury causes closure of vocal cords in median position, and a tracheostomy becomes necessary. Especially on left side of esophagus, RLN is so close to esophagus that it is easy to injure a nerve with a careless dissection.
Thus, dissection should be made close to esophageal muscle fibers to avoid this complication. As previously mentioned, thoracic duct connects to left Pirogoff angle, and it makes a slight connection to left side of esophagus. To avoid harm to thoracic duct, a careful dissection should be made, especially in cervical esophagectomy [ 8 , 9 ].
Measuring 16—18 cm in length, thoracic esophagus is in upper and posterior mediastinum. Running from 1st to 11th dorsal vertebra, it does not fit concavity of vertebral column. However, it changes location to left gradually from start to end. At beginning, it is located between vertebral column and trachea, slightly left of midline and 5 cm left of vertebral column at level of diaphragmatic hiatus Figure 4. Parietal sheet of pleura is tightly connected to both sides of vertebral column, and these connections cause esophageal-pleural recesses that make dissection of esophagus in thorax more difficult.
Thus, if a pleural rupture occurs in this area during surgery, fixing rupture can present a challenge for surgeon [ 2 ]. Arteries of Esophagus. As previously discussed, esophagus within thoracic cavity contains three classical narrowings, two conditional narrowings, and two curves. Most important and challenging structure in this region is thoracic duct, which lies behind esophagus throughout thorax. Thoracic duct is located slightly apart from esophagus in inferior third part of thorax, but it comes closer as esophagus goes upward.
Trachea, aortic arch, right pulmonary artery, left main bronchus, plexus of esophagus, pericardium, left atrium, and anterior vagus nerve are found anterior to esophagus.
At posterior side, esophagus connects to vertebral column, longus colli muscle, posterior intercostal arteries, azygos vein, hemiazygos vein, anterior wall of aorta, posterior vagal nerve, and pleura. Aortic arch, left subclavian artery, left inferior laryngeal nerve, left vagus nerve, thoracic ductus, and thoracic part of aorta are located on left side of esophagus. Azygos vein, pleura of mediastinum, right main bronchus, and right vagus nerve are located on right side.
Close proximity of upper two-thirds of esophagus to thoracic duct increases risk of thoracic duct injury in middle and upper mediastinal dissection of esophagus; thus, careful dissection should be performed in this area. The area between aortic arch and esophagus is comprised of aorticoesophagial muscle fibers that include large vessels; dissection of this area is fairly simple, except in the case of tumor invasion.
If tumoral invasion occurs among these large vessels, removal is challenging and dangerous. Upper mediastinum becomes narrower above aortic arch, and esophageal tumors can easily infiltrate left recurrent laryngeal nerve and respiratory system; however, aortic arch and azygos vein block tumors in these areas to infiltrate lower parts of mediastinum.
Lower parts of thoracic esophagus are surrounded by soft areolar tissue. Here esophagus is not touching adjacent organs and descends slightly away from the vertebral column, making dissection and resection easier and tumor infiltration more difficult in this area.
Two weak areas in esophagus that can be vulnerable to pulsing diverticula are upper and lower parts of a cricoid muscle. In addition, another weak area is located on left posterior esophageal wall, very close to diaphragmatic hiatus, spontaneous rupture of esophagus can occur [ 2 , 10 ]. Abdominal esophagus is 1—2. The plane passes through 7th rib cartilage and sternum anteriorly.
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