Abstract
Background
The structure of the fascia in upper mediastinum has already been reported from gross anatomical viewpoints by Sarrazin. But it is necessary to understand meticulous anatomy for thoracoscopic or mediastinoscopic surgery. So herein, we investigate histologically the thin membranous structure made of dense connective tissues.
Methods
Semi-sequential transverse sections of the mediastinum were obtained from three cadavers. Hematoxylin and eosin staining, Elastica van Gieson staining, and Masson trichrome staining were performed to identify the presence and location of the thin membranous structure made of dense connective tissues.
Results
The “visceral sheath” and “vascular sheath,” as previously described by Sarrazin, were observed histologically. These two thin membranous structures do not surround the esophagus and trachea cylindrically. In addition, the “visceral sheath” on the right side of the upper mediastinum was unclear in comparison to the left side. The “visceral sheath” (on the left side) gradually became unclear, and seemed to almost disappear; the esophagus was found to be very close to the thoracic duct on the caudal side of the bifurcation of the trachea. Although the left recurrent nerve was located inside the “visceral sheath” in all cadavers, the left recurrent nerve lymph nodes were located inside the “visceral sheath” in cadaver 1 and between the “visceral sheath” and “vascular sheath” in cadaver 3.
Conclusion
The “visceral sheath” around the esophagus in the upper mediastinum was histologically demonstrated; however, the findings were not constant.
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Acknowledgements
We thank Ms. Yoko Takagi for technical assistance in performing histological staining and Dr Kumiko Yamaguchi for technical support in anatomical procedure.
Funding
This work was partly supported by JSPS KAKENHI Grant Number JP23590216.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
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All authors declare that they have no conflict of interest.
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Tokairin, Y., Nakajima, Y., Kawada, K. et al. Histological study of the thin membranous structure made of dense connective tissue around the esophagus in the upper mediastinum. Esophagus 15, 272–280 (2018). https://doi.org/10.1007/s10388-018-0625-9
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DOI: https://doi.org/10.1007/s10388-018-0625-9