Esophagus

Extents:

From T4/5 to T10.

The esophagus runs downwards to the right then to the left of the aorta. It is the continuation of the cervical and superior mediastinal part.

• Anteriorly: the trachea and left subclavian artery. The left recurrent laryngeal nerve runs in the tracheoesophageal groove.
• Posteriorly: bodies of T1-4, with longus coli in the upper part.
• On the right: the right pleura and the arch of the azygous vein.
• On the left: the thoracic duct, left pleura and the arch of the aorta. It crosses behind the principal bronchus and the right right pulmonary artery.

• Anteriorly: left atrium, part of the left ventricle and lower down the thoracic diaphragm.
• Posteriorly: the right posterior intercostal arteries; thoracic duct, azygous, accessory hemiazygous and hemiazygous veins, and lower down, the descending aorta.
• On the right: the right pleura.
• On the left: the descending aorta and below that, the left pleura

Constrictions

It is related anteriorly to the heart and pericardium and can be dented in enlargement of the right atrium. Its normal constrictions are at the pharyngo-esophageal junction where it is crossed by the left principle bronchus and where it goes through the thoracic diaphragm at T10, are clinically important. The vagal plexus surrounds it, before reconstituting into anterior and posterior vagal trunks.

Blood supply

It is vascularized by a longitudinal anastomosis to which several vessels contribute. These include:

• Inferior thyroid
• Bronchial
• Aorta
• superior phrenic
• left gastric

The veins drain both to the portal vein and azygous system. The esophagus therefore constitutes a site of portosystemic anastomosis.

Lymphatic Drainage

Mediastinal lymph nodes
Supradiaphragmatic nodes

Innervation

Vagal trunks and sympathetic from sympathetic chain