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SF3 - Test 1 > 1 - Superior and Posterior Mediastinum > Flashcards

1 - Superior and Posterior Mediastinum Flashcards

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1
Q

Superior Mediastinum: Vessels

A

L/R Brachiocephalic Vein

Aoritic Arch

Brachiocephalic Trunk

Left Common Carotid

Left Subclavian

Superior Vena Cava

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2
Q

Superior Mediastinum: Nerves

A

Left Recurrent laryngeal Nerve

Phrenic Nerve

Vagus Nerve

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3
Q

Superior Mediastinum: Structures

A

Trachea

Esophagus

Thoracic Duct

Thymus (degrades with age)

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4
Q

Aoritic Arch: Location

A

Begins and ends at level of sternal angle (forms arch)

Located entirely in Superior Mediastinum

Courses Right to Left, and Anterior to Posterior

Branches: Braciocephalic Trunk, Left Common Carotid A. , Left Subclavian A.

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5
Q

Aortic Arch: Brachiocephalic Trunk

A

Largest branch of aortic arch

At right sternoclavicular joint, the trunk divides into: Right Common Carotid Artery, and Right Subclavian Artery

Arteries located slightly superior and posterior to corresponding veins

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6
Q

Aortic Arch: Left Common Carotid

A

Ascends left side of trachea

Left Head/Neck

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7
Q

Aortic Arch: Left Subclavian Artery

A

Ascends left side of trachea

Left upper extremity

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8
Q

Descending Thoracic Aorta: Location

A

Inferior to the level of sternal angle

Starts on left of thoracic vertebrae, gradually moves anterior

Passes through the Aortic Hiatus in the Diaphragm at Level T12

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9
Q

Descending Thoracic Aorta: Paired Branches

A

Paired Parietal Branches:

a. Nine pairs of Posterior Intercostal arteries supply 3-11 (1-2 supplied from Sup. Intercostal Br. of Costocervial Trunk - Branch of Subclavian)

b. One pair Subcostal Arteries (bellow rib 12)

c. One pair Superior Phrenic Arteries to upper side diaphragm

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10
Q

Descending Thoracic Aorta: Unpaired Branches

A

Unpaired Branches to Viscera

a. Two Left Bronchial Arteries
b. Two Esophageal Arteries

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11
Q

Veins in Sup/Post Mediastina: Right and left Brachiocephalic Veins

A

Formed by union of the internal jugular veins (head and neck) and the subclavian veins (upper extremities)

Begins posterior to Sternoclavicular Joints

- - -

Right - Goes basically straight down to Superior Vena Cava

Left - Oblique Cross over to join Right and form Superior Vena Cava; Located between Thymus and Brachiocephalic Truink and L Common Carotid

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12
Q

Veins in Sup/Post Mediastina: Superior Vena Cava

A

Formed by union of Right and left Brachiocephalic Veins

Extends from levels of right Ribs 1-3

Receives Azygos Vein at Sternal Angle, enters Right Atrium

Contains DEOXYGENATED blood from ALL STRUCTURES ABOVE DIAPHRAGM

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13
Q

Veins in Sup/Post Mediastina: Azygos Vein Location

A

Lies right of thoracic vertebrae

Superior continuation of right ascending lumbar vein

Passes through Aortic Hiatus of Diaphragm

Arches superior to root of right lung, to empty in Superior Vena Cava @ Sternal Angle

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14
Q

Veins in Sup/Post Mediastina: Azygos Drainage Pattern

A

Right Thoracic Wall via Posterior Intercostal Veins

Left Thoracic Wall vis Hemiazygos and Accessory Hemiazygos Veins

Esophagus (esophageal veins), lung tissue (bronchial veins), and the vertebral column and spinal cord (vertebral venous plexus)

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15
Q

Veins in Sup/Post Mediastina: Hemiazygos Vein (Inferior Hemiazygos)

A

Continuation of Left Ascending Lumbar Vein as it passes posterior diaphragm; drains left posterolateral abdominal wall into inferior vena cava (this branch becomes Hemiazygos)

Drains lower left intercostal spaces

Empties into Azygos

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16
Q

Veins in Sup/Post Mediastina: Accessory Hemiazygos Vein (Superior Hemiazygos)

A

Drains middle left intercostal spaces, empties into Azygos

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17
Q

What is the venous drainage patter for upper intercostals?

A

Right / Left Superior Intercostal Veins

These are NOT located in the posterior mediastinum, but do dump into veins there (Azygos, Left Brachiocephalic V.)

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18
Q

What provides a collateral pathway to right atrium for venous drainage?

A

Azygos Vein and Ascending Lumbar Veins provide collateral pathway to right atrium if Superior Vena Cava OR Inferior Vena Cava is blocked.

If they’re both blocked, you’re probably dead.

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19
Q

Clinical: Superior Vena Cava Syndrome

A

Bronchogenic Tumor of Right Lung can compress Superior Vena Cava

Head/Neck blood as difficulty returning to right atrium

Signs: Distended internal/external jugular veins in neck, subclavian tribs. in R upper limb

Still has collateral pathways (Aygos -> Asc. Lumbar V. -> Lumbar Veins -> Inferior Vena Cava)

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20
Q

Clinical: Liver Tumor Venous Compression

A

Tumor of Liver can obstruct Inferior Vena Cava

Venous blood can bypass via collaterals:

Lumbar Veins -> R/L Ascending Lumbar Veins -> Hemiazygos -> Azygos -> Superior Vena Cava

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21
Q

Lymphatics: Thoracic Duct

Overview

Study These Flashcards
A

Main lymph channels of body

Everything but Right Head/Neck, Right Pec, Right Arm

Drains into venous system

1st - Drain cisterna chyli

22
Q

Lymphatics: Thoracic Duct

Locations:

Posterior Mediastinum

Supermediastinum

Neck

Study These Flashcards
A

Ascends through aortic hiatus in diaphragm, enters posterior mediastinum

Posterior Mediastinum: Duct is between Azygos/Thoracic Aorta, Posterior to Esophagus

Superior Mediastinum: Duct is poster to left border of esophagus

Root of the Neck: Duct drains into the beginning of the left brachiocephalic vein

23
Q

Location of Cisterna Chyli

Study These Flashcards
A

Inferior to the diaphragm, anterior to L2, right of Aorta

24
Q

Drainage to thoracic duct in root of neck?

Study These Flashcards
A

Three lymph trunks:

  1. Left Jugular (head/neck)
  2. Left Subclavian (upper limb)
  3. Left Bronchomediastinal (left lung)
25
Lymphatics: Right Lymphatic Duct Location? Drains? Receives?
**Not** in mediastinum, found in **ride side of root of the neck** Drains into **right brachiocephalic vein** Drains: Right head/neck, right limb, right lung, skin of right thoracic wall Receives: Right Subclavian, Right Bronchomediastinal, Right Jugular Lymph Trunks These may drain **independently**
26
Phrenic Nerve: Superior Location (R/L)
Courses through superior and middle, **not posterior mediastinum** **- - -** Right: Enters from neck between **Right Subclavian A & V** **- - -** Left: Enters from beck between **Left Subclavian A & V; Crosses Arch of Aorta _anterior_ to left vagus nerve**
27
Phrenic Nerve: Middle Mediastinum Location
Between mediastinal parietal pleura and fibrous pericardium ## Footnote **Anterior to root of the lung**
28
Phrenic Nerve: Exit from Middle Mediastinum
Right: Passes through **caval opening (w/Inf. Vena Cava)** Left: Pierces **left dome** of the diaphragm
29
Vagus Nerve: Left Superior Mediastinum Location & Branch
Crosses left side of **aortic arch** **Gives off _Left Recurrent Laryngeal Nerve Branch;_ which hooks underneath Ligamentim Arteriosum & Aortic Arch; ascends into neck\***
30
Clinical: Left Recurrent Laryngeal Nerve
When ligating a **patent ductus arteriosus** in infant, **DO NOT** ligate the left recurrent laryngeal nerve. Provides motor innervation to laryngeal muscles; damage = **hoarse voice**
31
Vagus Nerve: Right Superior Mediastinum Location/Branches?
Enters **Anterior** to **Right Subclavian;** descends **lateral to Trachea** Gives off **Right Recurrent Laryngeal Nerve**, hooks around right subclavian artery, and ascends to neck b/t esophagus and trachea (**does NOT enter superior mediastinum)**
32
Vagus Nerve: Other Minor Branches in Superior Mediastinum
Small **cardiac / pulmonary** branches leave main Vagus trunk in Superior Mediastinum and course to **cardiac** and **pulmonary** plexuses
33
Vagus Nerve: Location in Posterior Mediastinum (in orientation to esophagus)
Passes **posterior to root of the lung**; gives additional fibers to pulmonary plexus Forms plexus on **surface of esophagus** **Passes through diaphragm with esophagus.** **- - -** **Left = Anterior Esophagus** **Right = Posterior Esophagus**
34
Sympathetic Trunks? Part of? Organization?
Part of **P****osterior Mediastinum** Two parallel cords punctuated by 11 or 12 ganglia; connected to adjacent thoracic spinal nerves by white and gray rami communicantes
35
Sympathetic Trunks: Location in Mediastinum?
Superior - Anterior to Neck of Ribs Inferiorly - Become medial, lie on lateral vertebrae Covered by parietal pleura on way down
36
What type of fibers originate from the upper five ganglia?
Small, Postganglionic Sympathetic Fibers Also contain Visceral Afferents
37
What type of fibers originate from lower seven ganglia?
Large Preganglionic Sympathetic Fibers Form three thoracic Splanchnic Nerves Also carry Visceral Afferents
38
Greater Splanchnic Nerve
(on each side) Usually arises from **5th** or **9th** or **10th** thoracic ganglia Descends across vertebral bodies medially, passes through **crus of diaphragm**, ends in **celiac ganglion**
39
Lesser Splanchnic Nerves Least Splanchnic Nerves
Lesser: 9+10 or 10+11 ganglia Pass through crus of diaphragm, end in **aorticorenal ganglion** **- - -** Least: 12th ganglia Pass through crus of diaphragm, end in **renal plexus**
40
Thymus: Organization Location Blood Supply
Bilobed, lympoid organ of the immune system--**max size @ puberty** Becomes fat after **Immediately Posterior to Manubrium (Sternum)** Blood Supply: Branches of Internal Thoracic / Inferior Thyroid
41
Trachea Location Division Location?
Begins in neck at **level of C6** Divides into **principle bronchi** **at level of sternal angle** Principle bronchi are within **middle mediastinum**
42
Right Main Bronchus vs Left Main Bronchus Clinical?
Right = **Shorter, Wider, more vertical (erect chode)** Left = Longer, more horizonatl, crosses **anterior to esophagus and aorta; may constrict esophagus** - - - Clinical: Food more likely to enter **Right Bronchus; more likely to enter middle or lower lobe of right lung**
43
Carina Clinical?
Internal "keel" at division of trachea into main bronchi Clinical: **Landmark**, visible with bronchoscope--enlargement of tracheobronchial lmph nodes due to bronchogenic carcinoma can cause **distortion of the carina**
44
Esophagus: Location in Neck/Superior Mediastinum Location in Posterior Mediastinum
Located between trachea and vertebral column - - - Descends from **level of sternal angle** to **esophageal hiatus** in diaphragm at level **T10** **Posterior** to pericardium, left atrium Right of thoracic aorta Anterior to thoracic aorta at esophageal hiatus in diaphragm Deviates **left (aorta right) as they descend**
45
Clinical: Constrictions of Esophagus Four Types?
Occur only when it's filled, due to adjacent structures compressing muscular tube. **Barium Dye Swallow** used to test - - - 1. Pharynx Narrows 2. Arch of Aorta 3. Left main Bronchus 4. Diaphragm
46
Clinical: Hypertrophy of Left Atrium
Occurs during left-side heart failure Can be from **incompetent mitral valve, resulting in back pressure of venous blood** Can be deonstrated with **barium swallow** by its **compression and** **displacement** of the posterior **esophagus**
47
Esophageal blood supply?
In Thorax: From esophageal branches of **Descending Aorta**
48
Diaphragm Passage: Vertebrae Level / Hole Inferior Vena Cava Esophagus Descending Aorta Greater, Lesser, Least Splanchnic Nerves Sympathetics
Inferior Vena Cava - **T8 - Caval Opening (R. Phrenic also)** Esophagus - **T10 - Esophageal Hiatus (R/L Vagal N. trunks also)** Descending Aorta - **T12** - **Aortic Hiatus (Thoracic Duct, Azygous Vein also--Red (Aorta), White (Thoracic Duct), Blue (Azygous))** Greater, Lesser, Least Splanchnic Nerves - **Crus** Sympathetics - Pass posterio, don't pierce
49
Anatomical Structures at Level of Sternal Angle (Seven)
1. Cotsal Cart. of Rib 2 articulate w/Sternum 2. Arch of Aorta begins, Term. @ Descending aorta 3. T4-T5 4. Imaginary line between Superior/Inferior Mediastina 5. Superior extends of fibrous pericardium 6. Trachea divides to main bronchi 7. Azygos Vein enters Superior Vena Cava
50

SF3 - Test 1 (28 decks)

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