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CP Exam I > Superior and Posterior Mediastinum > Flashcards

Superior and Posterior Mediastinum Flashcards

1
Q

What are the contents of the superior mediastinum from anterior to posterior?

A 
Thymus
Great vessels (veins then arteries)
Vagus and phrenic nerves
Left recurrent laryngeal nerve
Cardiac pulmonary plexus
Trachea
Esophagus
Thoracic duct
Prevertebral muscles
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2
Q

The great vessels are the second most anterior structures in the superior mediastinum after the thymus. What great vessels exist in this compartment?

A

Brachiocephalic veins
Superior vena cava

Arch of the aorta with its 3 branches: brachiocephalic trunk, left common carotid a., left subclavian a.

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3
Q

Describe the location of the posterior mediastinum based on vertebral level and surrounding structures

A

Anterior to T5-T12, posterior to the pericardium, superior to the diaphragm, and medial to the pleural cavities

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4
Q

What are the contents of the posterior mediastinum?

A 
Thoracic (descending) aorta
Thoracic duct
Lymph nodes
Azygous and hemiazygous veins
Esophagus
Vagus nerve
Esophageal plexus
Thoracic sympathetic trunks
Thoracic splanchnic nerves
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5
Q

What are the 4 major landmarks of the superior mediastinum?

A

Manubrium of sternum

Body of sternum

Blood vessels around manubrium

Thymus gland

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6
Q

The manubrium of the sternum is a superior mediastinal landmark. Which part of the manubrium corresponds to T2 vertebrae in men and T3 in women?

A

Suprasternal (jugular) notch

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7
Q

One of the landmarks for the superior mediastinum is the body of the sternum. The sternal angle connects to the second costal cartilage laterally. What is this a landmark for?

A

Bifurcation of the trachea and beginning of the aortic arch

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8
Q

What blood vessels can be found using the manubrium of the sternum as a landmark in the superior mediastinum?

A

Arch of the aorta

Right and left brachiocephalic veins

Brachiocephalic trunk, right subclavian vessels, common carotids

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9
Q

What superior mediastinal landmark is found behind the manubrium and body of the sternum?

A

Thymus gland

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10
Q

The cardiac and pulmonary plexus include the ______ nerves which run anterior to the roots of the lungs.

The ______ nerves run posterior to the root of the lung and give off the ________ nerve which hooks around the ligamentum arteriosum.

A

Phrenic

Vagus; left recurrent laryngeal

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11
Q

At what spinal cord levels would you find the sympathetic preganglionic cells of the cardiac and pulmonary plexus? Where are the postganglionics?

A

T1-T4/5; postganglionics in sympathetic chain

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12
Q

T/F: parasympathetic preganglionic fibers of the cardiac and pulmonary plexus are from the phrenic nerve

A

False; from the vagus nerve

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13
Q

Where would you find postganglionic parasympathetic fibers of the cardiac and pulmonary plexus?

A

Heart: Ganglia in epicardium/inner aortic arch

Lungs: small ganglia along bronchiolar tree

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14
Q

The usual pattern of branches of the aortic arch is present in 65% of people. What is the usual pattern?

A

Brachiocephalic trunk
Left common carotid a.
Left subclavian a.

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15
Q

Variations in the origin of the branches of the aortic arch are fairly common. In 27% of people, the left common carotid artery originates from the __________

A

Brachiocephalic trunk

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16
Q

Variations in the origin of the branches of the aortic arch are fairly common. A brachiocephalic trunk fails to form in approximately 2.5% of people. What happens in this case?

A

Each of the 4 arteries (right and left common carotid and subclavian arteries) originate independently from the arch of the aorta

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17
Q

Variations in the origin of the branches of the aortic arch are fairly common. In addition to the normal pattern, the _______ artery originates from the arch of the aorta in 5% of people

A

Left vertebral

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18
Q

T/F: both right and left brachiocephalic trunks originate from the aortic arch in approximately 1.2% of people

A

True

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19
Q

A __________________________ artery sometimes arises as the last (most left-sided) branch of the arch of the aorta. This artery crosses posterior to the esophagus to reach the right upper limb and may compress the esophagus, causing dysphagia

A

Retro-esophageal right subclavian

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20
Q

Variations in the origin of the branches of the aortic arch are fairly common. An accessory artery to the thyroid gland, the _________ artery, may arise from the arch of the aorta or the brachiocephalic artery

A

Thyroid ima

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21
Q

What are some anomalies that may occur with the aortic arch itself?

A

Right arch of the aorta (curves over root of right lung and passes inferiorly on right side)

Double arch of the aorta (forms vascular ring around esophagus and trachea, may cause compression)

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22
Q

What aortic branches are present in the posterior mediastinum?

A 
Superior phrenic aa.
Posterior intercostal aa.
Esophageal aa.
Bronchial aa.
Tracheal aa.
Supreme intercostal aa.
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23
Q

What veins are found in the superior mediastinum?

A 
Brachiocephalic vv.
Superior vena cava
Subclavian v.
Jugular v.
Supreme intercostal v.
24
Q

What veins are found in the posterior mediastinum?

A

Azygous v.
Hemiazygous v.
Accessory hemiazygous v.
Posterior intercostal v.

25
Q

What are the 3 primary sources of arterial supply to the diaphragm?

A

Internal thoracic arteries

Thoracic aorta

Abdominal aorta

26
Q

The 3 primary sources of arterial supply to the diaphragm include the internal thoracic arteries, the thoracic aorta, and the abdominal aorta.

What arteries come off the internal thoracic arteries to supply the diaphragm?

A

Musculophrenic aa.

Pericardiacophrenic aa.

27
Q

The 3 primary sources of arterial supply to the diaphragm include the internal thoracic arteries, the thoracic aorta, and the abdominal aorta.

What arteries come off the thoracic aorta to supply the diaphragm?

A

Superior phrenic aa.

28
Q

The 3 primary sources of arterial supply to the diaphragm include the internal thoracic arteries, the thoracic aorta, and the abdominal aorta.

What arteries come off the abdominal aorta to supply the diaphragm?

A

Inferior phrenic aa. (Although these sometimes arise from celiac trunk)

29
Q

The esophagus lies anterior to the bodies of ______ and ______ vertebrae.

It is divided into 3 parts ______, ______, and ________

A

Cervical; thoracic

Cervical (C6-T1), thoracic (T1-diaphragm hiatus), abdominal

30
Q

The esophagus descends slightly to the right of the ______ and pierces slightly left through the ________

A

Aorta; diaphragm

31
Q

What are the 4 constrictions of the esophagus?

A

Cricopharyngeus m. in cervical region

Aortic arch

Left bronchus

Diaphragm

32
Q

The esophagus is pushed to the right by the descending aorta, then it crosses over the aorta, heading left to the esophageal hiatus in the diaphragm.

What happens as a bolus of food passes through?

A

A bolus of food passes down the esophagus, the aortic arch, left primary bronchus and the diaphragm may constrict it

[Foreign objects may lodge here and strictures may form]

33
Q

What supplies innervation to the esophagus?

A

Esophageal plexus

34
Q

What nerves contribute to the esophageal plexus?

A

Left vagus (anterior) and right vagus (posterior) nn.

Thoracic postsynaptic sympathetic nerves

35
Q

Branches of the postsynaptic sympathetic nerves to the thoracic plexus form the ______ _______ _____

A

Thoracic sympathetic trunk

36
Q

What nerves are involved in the thoracic sympathetic trunk?

A

Greater splanchnic nn.

Lesser splanchnic nn.

Least splanchnic nn.

37
Q

________ splanchnic nerves are made up of presynaptic sympathetic fibers from T5-9 that gather and pass anteriorly through the diaphragm to relay in the celiac ganglion

A

Greater

38
Q

_______ splanchnic nerves go from T12 through the diaphragm to the renal plexus

A

Least

39
Q

_______ splanchnic nerves consist of presynaptic fibers for T10-11 that gather and pass into the abdomen to relay in the aorticorenal ganglion

A

Lesser

40
Q

The _________________ drains lymph from the right side of the head, neck, upper limb, and thoracic wall before emptying into the ______________

A

Right thoracic duct; right subclavian vein

41
Q

The ______________ drains lymph from the lower abdomen and limbs, pelvis, left side of head, neck, and thoracic wall before emptying into the __________________

A

Thoracic duct; left subclavian vein

42
Q

What drains 75% of the lymph from the body?

A

Thoracic duct

43
Q

The thoracic duct runs on the anterior face of vertebral bodies ________, posterior to the _________, and between the _____ vein and ____________ __________

A

T6-12; esophagus; azygous; descending aorta

44
Q

Describe the course of the thoracic duct in the superior mediastinum

A

Deviates left and approaches the left from the posterior, and terminates near the junction of the internal jugular vein and subclavian vein

45
Q

What terminates in the same location as the thoracic duct but on the right side?

A

Right lymphatic duct

46
Q

Enlargement of the mediastinal lymph nodes (which may occur in conditions like lung cancer), can impinge on which nerves in the mediastinum? What might this cause?

A

Vagal nerves

Impinging on the left recurrent laryngeal nerve can cause hoarseness, disrupting speech

47
Q

Which subdivision of the mediastinum is the smallest, lying between the body of the sternum and transversus thoracis mm anteriorly, and the pericardium posteriorly?

A

Anterior mediastinum

48
Q

What are the contents of the anterior subdivision of the mediastinum?

A

Loose CT (sternopericardial ligaments)
Fat
Lymphatic vessels
A few LNs
Branches of the internal thoracic vessels
Inferior part of thymus (in infants and children)

49
Q

The ______ constitutes the primary posterior relationship of the base of the heart

A

Esophagus

50
Q

Describe the blood supply to the esophagus

A

Esophageal arteries (there are usually 2 but can be as many as 5), which branch from the descending aorta

51
Q

The thoracic duct originates from the _____ ____ in the abdomen and ascends through the ____ ____ in the diaphragm

A

Cisterna chyli; aortic hiatus

52
Q

What group of lymph nodes lies in the mediastinum posterior to the pericardium in relation to the esophagus and thoracic aorta? What do these receive lymph from and drain to?

A

Posterior mediastinal LNs

Receive lymph from esophagus, posterior aspect of pericardium and diaphragm, and middle posterior intercostal spaces

Drain to right or left venous angles via right lymphatic duct or thoracic duct

53
Q

What venous system, located on each side of the vertebral column, is responsible for draining the back and thoracoabdominal walls and mediastinal viscera?

A

Azygous venous system

54
Q

Where does the azygous vein, and its main tributary the hemiazygous vein, typically arise from?

A

“Roots” arising from posterior aspect of IVC and/or renal vein, which merge with the ascending lumbar veins

55
Q

Describe the participation of the azygous venous system in a collateral pathway

A

Azygous venous system forms a collateral pathway between the SVC and IVC and drains blood from the posterior walls of the thorax and abdomen - thus bypassing the terminal portion of the IVC

56
Q

What are the 3 major veins that drain into the azygous system?

A

Mediastinal vein
Esophageal vein
Bronchial vein

CP Exam I (18 decks)

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