Thorax 8 - Posterior Mediastinum Flashcards

1
Q

Describe how the physiological cardiac sphincter works.

A

Contraction of the diaphragm squeezes the oesophagus closed, preventing back flow into the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the name given to the anastomosis between the portal and systemic circulations?

A

Porto-systemic/Portocaval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 constrictions in the oesophagus caused by?

A

Arch of aorta
Left main bronchus
Left atrium of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the order of lymph drainage in the pulmonary region.

A

Pulmonary —> Bronchopulmonary —> Inferior and Superior Tracheobroncheal —> Paratracheal —> Bronchomediastinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does lymph from posterior mediastinal nodes drain to?

A

Paratracheal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where does lymph from anterior mediastinal nodes and parasternal nodes drain to ?

A

Bronchomediastinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the 5 birds that cross the diaphragm.

A
Azy-goose
Hemiazy-goose
Va-goose
Oesopha-goose
Thoracic Duck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Boundaries of the superior mediastinum:

A

Thoracic inlet

Plane b/n sternal angle & T4/5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Boundaries of the inferior mediastinum:

A

Plane b/n sternal angle T4/5

Thoracic outlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Boundaries of the posterior mediastinum:

A

Posterior to pericardial sac & diaphragm
T4/5 vertebral level
T12 vertebral level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The aortic hiatus in the diaphragm lies between the crura and ………… the median arcuate ligament.

A

Behind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Between which landmarks in the posterior mediastinum does the descending thoracic aorta lie?

A

T4/5 vertebral level aka 2nd CC

Aortic hiatus @ T12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the oesophageal arteries supply?

A

Middle third of the oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do the 9 posterior intercostal arteries supply?

A

Lower 9 intercostal spaces (3 - 11)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which arteries lie inferior to the 12th rib and supply the posterior abdominal wall?

A

Subcostal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many bronchial arteries are there on each side of the descending thoracic aorta?

A

2 left

1 right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the length and width of the oesophagus?

A

25cm long

2cm diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does the oesophagus lie in relation to the trachea and the aorta in the superior mediastinum?

A

Posterior to the trachea

Right of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where does the oesophagus lie in relation to the aorta just prior to piercing the diaphragm in the posterior mediastinum?

A

Anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

At what vertebral level does the oesophagus pierce the diaphragm?

A

T10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At what vertebral level does the aorta pierce the diaphragm via the aortic hiatus?

A

T12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What type of muscle is present in the oesophageal walls?

A

Upper third = striated (swallowing is voluntary)
Middle third = mixed
Lower third = smooth muscle

23
Q

Where does the crico-pharyngeal sphincter lie and what is its purpose?

A

Between the pharynx and the oesophagus

Prevents air being sucked into the stomach during inhalation

24
Q

What is the function of the cardiac sphincter?

A

To prevent gastric reflux

25
Q

Which diaphragmatic crus does the oesophagus pass through?

A

Right crus

26
Q

What is the arterial supply, venous drainage, nervous supply and lymph drainage of the superior (cervical) third of the oesophagus (beginning at C6)?

A
  • Arterial supply from inferior thyroid arteries
  • Venous drainage to brachiocephalic veins
  • Nerve supply from branches of the vagus nerves (recurrent laryngeal nerves)
  • Lymphatics drain to deep cervical nodes
27
Q

What is the arterial supply, venous drainage, nervous supply and lymph drainage of the middle (thoracic) third of the oesophagus?

A
  • Arterial supply direct from thoracic aorta and bronchial arteries
  • Venous drainage to azygous system (systemic)
  • Nerve supply from oesophageal plexus (vagus & sympathetic)
  • Lymphatics drain to tracheobronchial nodes
28
Q

What is the arterial supply, venous drainage, nervous supply and lymph drainage of the inferior (abdominal) third of the oesophagus?

A
  • Arterial supply from the left gastric artery
  • Venous drainage to left gastric veins and therefore to portal vein
  • Nerve supply from branches of the oesophageal plexus (vagus & sympathetic)
  • Lymphatics drain to left gastric and coeliac nodes
29
Q

What is special about the submucosal veins?

A

Form an anastomosis between middle and inferior thirds of the oesophagus and therefore is a porto-systemic or portocaval anastomosis

30
Q

How can cirrhotic liver disease cause fatal haemorrhage?

A

Raises portal venous pressure, causing portal hypertension, dilating first the submucosal and then the azygos vein and making the latter tortuous, leading to oesophageal varicies –> fatal haemorrhage

31
Q

Where do the 4 oesophageal constrictions occur?

A

Upper oesophageal sphincter 17cm
Arch of aorta
Left main bronchus at 28cm
Diaphragm (lower oesophageal sphincter) at 43cm

(Indentation rather than constriction of left atrium

32
Q

What structures lie anterior to the oesophagus?

A
Trachea
Right pulmonary artery
Left main bronchus
LA
Diaphragm
33
Q

What structure lies to the right of the oesophagus?

A

Azygous vein

34
Q

What structure lies to the left of the oesophagus?

A

Thoracic aorta

35
Q

What is the thoracic duct a continuation of?

A

Cisternae chyli

36
Q

What two structures does the thoracic duct lie between?

A

Azygous vein

Aorta

37
Q

At what vertebral level does the thoracic duct cross to ascend the oesophagus on its left side?

A

T4/5

38
Q

What will damage of the thoracic duct lead to?

A

Leaking of lymph –> chylothorax

39
Q

List the 3 types of ‘tracheal’ lymph nodes.

A

Superior tracheobronchial
Inferior tracheobronchial
Paratracheal (alongside the trachea)

40
Q

Where are the anterior mediastinal lymph nodes clustered?

A

BCV

41
Q

Where do the posterior mediastinal lymph nodes lie?

A

Behind the heart and adjacent to the oesophagus

42
Q

Where do the thoracic duct and the azygous vein peirce the diaphragm?

A

At the aortic hiatus - T12

43
Q

List the pattern of lymph drainage of the thorax.

A

Pulmonary
Bronchopulmonary
Inf. and Sup. Tracheobroncial Post. Mediastinal
Paratracheal Parasternal Ant. Mediastinal
Bronchomediastinal Lymph Trunks

44
Q

Which 3 lymph trunks does the thoracic duct receive before entering the BCV?

A

(Left) Jugular Lymph Trunk (Head & Neck)
(Left) Subclavian Lymph Trunk (UL)
(Left) Bronchomediastinal Trunk (Left Thorax)

45
Q

Which 3 lymph trunks does the thoracic duct receive before entering the LBCV?

A

(Left) Jugular Lymph Trunk (Head & Neck)
(Left) Subclavian Lymph Trunk (UL)
(Left) Bronchomediastinal Trunk (Left Thorax)

46
Q

Which 3 lymph trunks does the right lymphatic duct receive before entering the RBCV?

A

(Right) Jugular Lymph Trunk (H & N)
(Right) Subclavian Lymph Trunk (UL)
(Right) Bronchomediastinal Trunk (Right thorax)

47
Q

What structures does the azygous vein drain?

A

Posterior thoracic walls

Part of the abdomen

48
Q

From which veins does the azygous originate and which vein does it drain into?

A

Originates: Subcostal & Lumbar veins

Drains to: SVC

49
Q

Where does it drain into the SVC?

A

2nd right CC

50
Q

Which important vein does the hemi-azygous (lower) have connections with?

A

Left renal vein

51
Q

At which vertebral level does the hemi-azygous (lower) vein cross to the RHS?

A

T9

52
Q

At what vertebral level does the accessory hemi-azygous (upper) cross to the RHS?

A

T8

53
Q

From which intercostal space does the accessory hemi-azygous (upper) vein descend from?

A

4th intercostal space