no 



TOPOGRAPHIC AND APPLIED ANATOMY. 



accomplished by simply dividing all of the large vessels. When this is done, the posterior wall 

 of the pericardium with the lumina of the blood-vessels is distinctly visible (Fig. 51). The 

 posterior pericardial wall possesses no reflection of mediastinal pleura, but is directly in contact 

 with the loose connective tissue of that portion of the mediastinal space which is situated behind 

 the heart (see Fig. 50). In this location the structure nearest to the heart is the esophagus, which 

 often forms a slight prominence in the pericardial sac, and which may always be palpated through 

 the pericardium in the dead subject and easily exposed (Fig. 51). 



Thyroid gland 



Left jugular vein 

 Left subclavian vein 



Left innominate vein 



Trachea 

 Clavicle 



Subclavian muscle 



Lymphatic gland 



- Right innominate v. 



Innominate artery 



Pericardium 



- - Diaphragm 



Broad ligament of liver 



FIG. 52. The anterior thoracic wall with the pericardium and the diaphragm seen from within. The dashed 

 and dotted lines represent the anterior pleural limits; between them, at the level of the fifth left costal cartilage, is the 

 site for aspiration of the pericardial cavity. (Formalin preparation.) 



It is at this point that the deposition of a considerable quantity of pericardial exudate may 

 press upon the esophagus and produce dysphagia. By irritation of the vagus nerve (Fig. 51) 

 pericarditis in this situation may also cause vomiting, hiccough, and paralysis of the vocal cords. 

 This practical and important relation will be referred to again when we discuss the esophagus 

 in detail. 



